title: Changes in myocardial lactate, pyruvate and lactate-pyruvate ratio during cardiopulmonary bypass for elective adult cardiac surgery: Early indicator of morbidity.
abstract: BACKGROUND
  Myocardial lactate assays have been established as a standard method to compare various myocardial protection strategies. This study was designed to test whether coronary sinus (CS) lactates, pyruvate and lactate-pyruvate (LP) ratio correlates with myocardial dysfunction and predict postoperative outcomes.
  
  
  METHODS
  This prospective observational study was conducted on 40 adult patients undergoing elective cardiac surgery with the aid of cardiopulmonary bypass (CPB). CS blood sampling was done for estimation of myocardial lactate (ML), pyruvate (MP) and lactate-pyruvate ratio (MLPR) namely: pre-CPB (T(1)), after removal of aortic cross clamp (T(2)) and 30 minutes post-CPB (T(3)).
  
  
  RESULTS
  Baseline myocardial LPR strongly correlated with Troponin-I at T1 (σ: 0.6). Patients were sub grouped according to the median value of myocardial lactate (2.9) at baseline T1 into low myocardial lactate (LML) group, mean (2.39±0.4 mmol/l), n=19 and a high myocardial lactate (HML) group, mean (3.65±0.9 mmol/l), n = 21. A significant increase in PL, ML, MLPR and TropI occurred in both groups as compared to baseline. Patients in HML group had significant longer period of ICU stay. Patients with higher inotrope score had significantly higher ML (T2, T3). ML with a baseline value of 2.9 mmol/l had 70.83% sensitivity and 62.5% specificity (ROC area: 0.7109 Std error: 0.09) while myocardial pyruvate with a baseline value of 0.07 mmol/l has 79.17% sensitivity and 68.75% specificity (ROC area: 0.7852, Std error: 0.0765) for predicting inotrope requirement after CPB.
  
  
  CONCLUSIONS
  CS lactate, pyruvate and LP ratio correlate with myocardial function and can predict postoperative outcome.
authors.affiliation: Department of Cardiac Anaesthesia and CTVS, CN Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Pm
authors.initials: P
authors.lastname: Kapoor
authors.forename: B
authors.initials: B
authors.lastname: Mandal
authors.forename: Uk
authors.initials: U
authors.lastname: Chowdhury
authors.forename: Sp
authors.initials: S
authors.lastname: Singh
authors.forename: U
authors.initials: U
authors.lastname: Kiran