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