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Am J Physiol Heart Circ Physiol 278: H1345-H1351, 2000;
0363-6135/00 $5.00
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Vol. 278, Issue 4, H1345-H1351, April 2000

Myocardial substrate metabolism influences left ventricular energetics in vivo

Christian Korvald, Odd Petter Elvenes, and Truls Myrmel

Department of Thoracic and Cardiovascular Surgery, University Hospital in Tromsø, N-9038 Tromsø, Norway

The myocardial oxygen consumption (MVO2) to left ventricular pressure-volume area (PVA) relationship is assumed unaltered by substrates, despite varying phosphate-to-oxygen ratios and possible excess MVO2 associated with fatty acid consumption. The validity of this assumption was tested in vivo. Left ventricular volumes and pressures were assessed with a combined conductance-pressure catheter in eight anesthetized pigs. MVO2 was calculated from coronary flow and arterial-coronary sinus O2 differences. Metabolism was altered by glucose-insulin-potassium (GIK) or Intralipid-heparin (IH) infusions in random order and monitored with [14C]glucose and [3H]oleate tracers. Profound shifts in glucose and fatty acid oxidation were observed. Contractility, coronary flow, and slope of the MVO2-PVA relationship were unchanged during GIK and IH infusions. MVO2 at zero PVA (unloaded MVO2) was 0.16 ± 0.13 J · beat-1 · 100 g-1 higher during IH compared with GIK infusion (P = 0.001), a 48% increase. The study demonstrates a marked energetic advantage of glucose oxidation in the myocardium, profoundly affecting the MVO2-PVA relationship. This may in part explain the "oxygen-wasting" effect of lipid-enhancing interventions such as adrenergic drugs and ischemia.

left ventricle; cardiac energetics; pressure-volume area; glucose-insulin-potassium


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