Lactate in cardiogenic shock - current understanding and clinical implications

Area of Science:

• Biochemistry
• Human Physiology
• Metabolic Research

Background:

• Adenosine triphosphate (ATP) is vital for human metabolism, primarily produced by mitochondrial oxidative phosphorylation.
• Acetyl-CoA in the heart is synthesized from free fatty acids (FFA) and pyruvate oxidation.
• Pyruvate, derived from glycolysis, can be converted to acetyl-CoA or lactate, influencing aerobic glucose metabolism.

Purpose of the Study:

• To review recent advances in understanding lactate metabolic flux.
• To contest the traditional paradigm of lactate accumulation in anaerobic conditions.
• To reaffirm the clinical significance of lactate in cardiovascular diseases.

Main Methods:

• Literature review of contemporary reports on lactate metabolism.
• Analysis of molecular biology, genetics, and physiology findings.
• Examination of lactate's role in cardiovascular disease prognostication.

Main Results:

• Contemporary reports challenge the notion of increased lactate production solely in anaerobic states.
• Lactate's role in aerobic glucose metabolism is complex and regulated.
• Lactate remains a significant prognostic factor in cardiovascular diseases.

Conclusions:

• The understanding of lactate's metabolic flux has evolved beyond anaerobic accumulation.
• Lactate's diagnostic and prognostic value is confirmed in cardiovascular applications, including ventricular-assist devices and biochips.