Elsevier

The Lancet

Volume 353, Issue 9161, 17 April 1999, Pages 1321-1323
The Lancet

Early Report
Haemodynamic effects of intracoronary pyruvate in patients with congestive heart failure: an open study

https://doi.org/10.1016/S0140-6736(98)06423-XGet rights and content

Summary

Background

Pyruvate, as an intermediate in the Krebs cycle, is an important source of energy for myocardium and improves contractility of normal, hypoxic, and postischaemic animal myocardium. We investigated the effect of intracoronary pyruvate in patients with congestive heart failure.

Methods

Haemodynamic measurements were done in eight patients with dilated cardiomyopathy after two 15 min infusions of pyruvate into the left main coronary artery and after saline washout of pyruvate.

Findings

There were no significant differences between the two pyruvate concentrations. Application of pyruvate resulted in a 23% increase in cardiac index (p<0·05), a 38% increase in stroke-volume index (p<0·05), and a 36% decrease in pulmonary capillary wedge pressure (p<0·05). Heart rate decreased significantly by 11%. Mean aortic pressure and systemic vascular resistance did not change. Most of the effects of pyruvate were reversed 15 min after the infusion stopped.

Interpretation

Pyruvate has the profile of a favourable inotropic substance. Other modes of administration need to be studied.

Introduction

Inotropic drugs such as catecholamines and phosphodiesterase inhibitors benefit patients with acute heart failure and cardiogenic shock, but the associated increase in intracellular calcium concentration, heart rate, and energy consumption is potentially harmful.1, 2

Several studies have found that pyruvate has positive inotropic actions in normal, hypoxic, and postischaemic animal myocardium as well as in isolated failing human myocardium.3, 4, 5 Pyruvate is a key intermediate in the glycolytic and pyruvate dehydrogenase pathways, which suggests that optimisation of energy production in the myocardium may be important. We investigated the haemodynamic response to pyruvate in patients with congestive heart failure due to dilated cardiomyopathy.

Section snippets

Methods

Eight consecutive patients with congestive heart failure, NYHA class III, were studied. Two patients were women, the median age was 56 years (range 43–72 years). All patients had a left-ventricular ejection fraction below 25% and a cardiac index below 2·5 L/min per m2 or pulmonary capillary-wedge pressure above 15 mm Hg. All patients were in sinus rhythm and gave written informed consent.

Cardiac catheterisation was done from the right femoral artery and vein with all medication having been

Results

One patient did not have the pyruvate infusion at the higher rate because the pulmonary capillary-wedge pressure decreased by 75%. There were no significant differences in any of the haemodynamic measurements between the two pyruvate infusion rates. Pyruvate increased stroke-volume index and decreased pulmonary capillary-wedge pressure in each patient. Compared with baseline, pyruvate increased stroke-volume index by 38% p<0·05 (figure 1) and decreased pulmonary capillary-wedge pressure by 36%

Discussion

Intracoronary pyruvate at supraphysiological concentrations increases cardiac output and decreases pulmonary capillary-wedge pressure and heart rate in patients with dilated cardiomyopathy and heart failure.

These haemodynamic effects were most likely due to a direct action of pyruvate on the myocardium because systemic pyruvate concentrations did not increase significantly and mean arterial pressure and systemic vascular resistance did not significantly change. Other studies have shown that

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