Metabolic modulation of myocardial ischemia.
The metabolic pathways of the heart during normoxia and ischemia have been well studied. High plasma fatty acid concentrations and the myocardial accumulation of long-chain fatty acyl metabolites during ischemia correlate with increased morbidity and mortality. However, enhanced glucose use can maintain cell homeostasis, diminish ischemic injury, and be clinically beneficial. Metabolic modulators represent a new class of drugs with the potential to treat myocardial ischemia. They are ideal as adjunctive anti-ischemic therapy because they lack the hemodynamic consequences of traditional therapy and treat the underlying metabolic dysfunction that leads to contractile failure and arrhythmias. Clinical studies have demonstrated their efficacy in acute and chronic settings. It is anticipated that there will be greater utilization of this new class of agents in the near future.
Jani
Sonal
S
Division of Cardiology, Beth Israel Medical Center, Baird 5, 16th Street and First Avenue, New York, NY 10003, USA.
Bergmann
Steven R
SR
D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D004791:Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D005227:Fatty Acids / Q000378:metabolism; D005947:Glucose / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use; D006801:Humans; D007328:Insulin / Q000494:pharmacology / Q000627:therapeutic use; D007773:Lactates / Q000378:metabolism; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000378:metabolism*; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D010084:Oxidation-Reduction; D011188:Potassium / Q000494:pharmacology / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D004791:Enzyme Inhibitors; D005227:Fatty Acids; D007328:Insulin; D007773:Lactates; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium