Changes in myocardial energy metabolism in elective coronary angioplasty.
OBJECTIVE
The aim was to investigate the effect of coronary angioplasty on myocardial energy metabolism, and to assure the safety of the procedure in patients with coronary heart disease.


METHODS
Before angioplasty a catheter was introduced into the coronary sinus. Blood samples were taken simultaneously from femoral artery and coronary sinus before balloon inflation, upon balloon deflation, and two minutes later, and arteriovenous differences in myocardial substrates, pH, PCO2, oxygen saturation, and adenosine catabolites were determined.


METHODS
14 patients with angiographically documented coronary artery disease with lesions in the left coronary artery suitable for elective coronary angioplasty were included in the study.


RESULTS
During balloon inflation the positive femoroarterial-coronary sinus difference of lactate turned negative, from 0.21(SEM 0.05) mM to -0.10(0.11)mM, p less than 0.02. At the same time pH and PCO2 differences increased: from 0.04(0.00) U to 0.07(0.01) U, p less than 0.01, and from -1.15(0.10) kPa to -1.41(0.10) kPa, p less than 0.01, respectively. The changes were, however, transient and the arteriovenous differences in these metabolic variables rapidly returned towards preinflation levels after balloon deflation. The femoroarterial-coronary sinus concentration differences in glucose and free fatty acids became positive in coronary angioplasty. The energy state remained good during the procedure as assessed from the negligible net efflux of adenosine and its degradation products.


CONCLUSIONS
Elective coronary angioplasty can be performed without any persistent derangements in myocardial metabolism, and may in fact lead to improvement of utilisation of some myocardial substrates. Lactate appears to be a more sensitive indicator of short term ischaemia than adenosine degradation products.
Peuhkurinen
K
K
Department of Internal Medicine, Oulu University Central Hospital, Finland.
Ikäheimo
M
M
Airaksinen
J
J
Huikuri
H
H
Linnaluoto
M
M
Takkunen
J
J
D000241:Adenosine / Q000378:metabolism; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002245:Carbon Dioxide / Q000097:blood; D004734:Energy Metabolism; D005230:Fatty Acids, Nonesterified / Q000378:metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism*
D005230:Fatty Acids, Nonesterified; D002245:Carbon Dioxide; D000241:Adenosine