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Myocardial release of hypoxanthine and lactate during percutaneous transluminal coronary angioplasty
P W Serruys1, H Suryapranata, F Piscione
1Catheterization and Cardiochemical Laboratories, Erasmus University, Rotterdam, The Netherlands.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) temporarily alters myocardial metabolism, but repeated occlusions do not cause permanent damage. Lactate and hypoxanthine levels return to normal quickly after the procedure, showing metabolic reversibility.
Area of Science:
- Cardiology
- Biochemistry
- Physiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) involves temporary coronary artery occlusion.
- Understanding myocardial metabolic response during PTCA is crucial for patient outcomes.
Purpose of the Study:
- To investigate myocardial lactate and hypoxanthine metabolism during repeated PTCA occlusions.
- To assess the reversibility of metabolic changes after PTCA.
Main Methods:
- Studied 15 patients undergoing PTCA with at least 4 balloon inflations.
- Measured coronary venous blood flow using thermodilution.
- Analyzed arteriovenous lactate and hypoxanthine differences.
Main Results:
- Coronary blood flow significantly decreased with repeated occlusions (p < 0.005).
- Peak lactate and hypoxanthine differences occurred after the first two occlusions.
- Metabolic disturbances resolved rapidly post-procedure, indicating reversibility.
Conclusions:
- Repeated PTCA occlusions do not lead to permanent alterations in myocardial lactate or hypoxanthine metabolism.
- Metabolic changes induced by PTCA are reversible within minutes after procedure completion.
Abstract:
The response of myocardial lactate and hypoxanthine metabolism during percutaneous transluminal coronary angioplasty was studied in a series of 15 patients undergoing this procedure. A minimum of 4 balloon inflations was performed per patient with an average duration per occlusion of 49 +/- 11 seconds (mean +/- standard deviation) for a total occlusion time of 192 +/- 40 seconds. Thermodilution coronary venous blood flow measured in the great cardiac vein decreased from control values of 72 +/- 4 ml/min (mean +/- standard error of the mean) to 47 +/- 10 ml/min with the fourth coronary occlusion (p less than 0.005). Arteriovenous lactate and hypoxanthine showed peak differences during the reactive hyperemia after the first 2 occlusions which did not increase after subsequent occlusions. Within minutes after the procedure, lactate and hypoxanthine efflux was no longer seen, demonstrating the reversibility of the metabolic disturbances after repeated ischemia. The results of this study indicate that there is no permanent alteration in lactate or hypoxanthine metabolism after percutaneous transluminal coronary angioplasty with 4 coronary occlusions of 40 to 60 seconds' duration, with a total occlusion time of 192 +/- 40 seconds.