title: Left ventricular assist device effects on metabolic substrates in the failing heart.
abstract: BACKGROUND
  Heart failure patients have inadequate nutritional intake and alterations in metabolism contributing to an overall energy depleted state. Left ventricular assist device (LVAD) support is a common and successful intervention in patients with end-stage heart failure. LVAD support leads to alterations in cardiac output, functional status, neurohormonal activity and transcriptional profiles but the effects of LVADs on myocardial metabolism are unknown. This study set out to measure cardiac metabolites in non-failing hearts, failing hearts, and hearts post-LVAD support.
  
  
  METHODS
  The study population consisted of 8 non-ischemic failing (at LVAD implant) and 8 post-LVAD hearts, plus 8 non-failing hearts obtained from the tissue bank at the University of Colorado. NMR spectroscopy was utilized to evaluate differences in myocardial energy substrates. Paired and non-paired t-tests were used to determine differences between the appropriate groups.
  
  
  RESULTS
  Glucose and lactate values both decreased from non-failing to failing hearts and increased again significantly in the (paired) post-LVAD hearts. Glutamine, alanine, and aromatic amino acids decreased from non-failing to failing hearts and did not change significantly post-LVAD. Total creatine and succinate decreased from non-failing to failing hearts and did not change significantly post-LVAD.
  
  
  CONCLUSIONS
  Measured metabolites related to glucose metabolism are diminished in failing hearts, but recovered their values post-LVAD. This differed from the amino acid levels, which decreased in heart failure but did not recover following LVAD. Creatine and the citric acid cycle intermediate succinate followed a similar pattern as the amino acid levels.
authors.affiliation: Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. Lindsay.Weitzel@ucdenver.edu
authors.forename: Lindsay B
authors.initials: LB
authors.lastname: Weitzel
authors.forename: Amrut V
authors.initials: AV
authors.lastname: Ambardekar
authors.forename: Andreas
authors.initials: A
authors.lastname: Brieke
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Cleveland
authors.forename: Natalie J
authors.initials: NJ
authors.lastname: Serkova
authors.forename: Paul E
authors.initials: PE
authors.lastname: Wischmeyer
authors.forename: Brian D
authors.initials: BD
authors.lastname: Lowes
mesh_terms: D000328:Adult; D000409:Alanine / Q000378:metabolism; D024322:Amino Acids, Aromatic / Q000378:metabolism; D016022:Case-Control Studies; D003401:Creatine / Q000378:metabolism; D005260:Female; D005947:Glucose / Q000378:metabolism; D005973:Glutamine / Q000378:metabolism; D006333:Heart Failure / Q000378:metabolism* / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D019802:Succinic Acid / Q000378:metabolism
chemical_list: D024322:Amino Acids, Aromatic; D005973:Glutamine; D019344:Lactic Acid; D019802:Succinic Acid; D005947:Glucose; D003401:Creatine; D000409:Alanine
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