Improved systolic and diastolic myocardial function with intracoronary pyruvate in patients with congestive heart failure.
BACKGROUND
Pyruvate increases myocardial performance in isolated myocardium and improves hemodynamics in patients with congestive heart failure.


OBJECTIVE
To investigate the influence of pyruvate on detailed parameters of systolic and diastolic left ventricular (LV) function.


RESULTS
In patients with heart failure due to dilated cardiomyopathy (LVEF 30+/-4%, n=9) pyruvate was infused intracoronarily. LV function was analysed before, during and after application of different pyruvate concentrations using a LV-micromanometer catheter. LV volumes were determined using cine ventriculography. Pyruvate increased maximum rate of LV isovolumic pressure rise (Peak +dP/dt) from 802+/-106 to 1125+/-103 mmHg/s (P<0.05). Left ventricular end-diastolic pressure declined in parallel from 17+/-2 to 12+/-2 mmHg (P<0.05) and heart rate decreased from 79+/-4 to 72+/-5 min(-1) (P<0.05). Stroke volume index increased from 34+/-4 to 43+/-6 ml/m(2) (P<0.05), end-diastolic LV volume remained unchanged, thus left ventricular ejection fraction increased with pyruvate from 30+/-4 to 39+/-4% (P<0.05). Maximum rate of LV isovolumic pressure decline (Peak -dP/dt) was significantly increased with pyruvate (from 794+/-94 to 980+/-108 mmHg/s; P<0.05) and mean arterial pressure increased from 80+/-5 to 88+/-4 mmHg (P<0.05). Discontinuation of pyruvate resulted in immediate reversibility of its effects.


CONCLUSIONS
Intracoronary pyruvate improves systolic and diastolic myocardial function and increases ejection fraction without increasing heart rate. Pyruvate thus exhibits the profile of a favourable inotropic agent, however, further investigation for the treatment of patients with acute heart failure is mandatory.
Hermann
Hans-Peter
HP
Abteilung Kardiologie und Pneumologie, Georg-August-Universität Göttingen, Robert-Koch-Str. 40, Göttingen D-37075, Germany. phermann@med-uni-goettingen.de
Arp
Jordis
J
Pieske
Burkert
B
Kögler
Harald
H
Baron
Steffen
S
Janssen
Paul M L
PM
Hasenfuss
Gerd
G
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D019289:Pyruvic Acid / Q000627:therapeutic use*; D013318:Stroke Volume; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects*
D002316:Cardiotonic Agents; D019289:Pyruvic Acid