虚血後心筋症に対する乳酸投与の影響：体外研究
Neven Stevic1,2, René Ferrera1, Delphine Baetz1
1Université Claude Bernard Lyon 1, CarMeN laboratory, INSERM, INRAE, 69500, Bron, France.
Background:
In vivo studies have reported cardiovascular benefits of lactate administration after cardiac arrest (CA). However, it remains unclear whether these improvements are due to direct or indirect myocardial effects of lactate. Therefore, we investigated the effects of lactate administration in an ex vivo CA model.
Methods:
Isolated rat hearts were subjected to 20 min of non-shockable CA followed by 40 min of reperfusion. Four groups were analyzed: Control (n=9), reperfused with standard Krebs buffer; Lactate (n=9), reperfused with Krebs containing 20 mmol/L L-lactate; Lact5min (n=5), reperfused with Krebs for 5 min and then with Krebs containing 20 mmol/L L-lactate; LactHyper (n=6), reperfused with hypertonic (Na+ 163 mmol/L) Krebs containing 20 mmol/L L-lactate. Endpoints included rate-pressure product (RPP), left ventricular enddiastolic pressure (LVEDP), coronary flow (CF) and arrhythmia incidence. Troponin and creatine kinase (CK) release, mitochondrial calcium retention capacity (CRC) and mitochondrial respiration were assessed.
Results:
RPP recovery at the end of reperfusion was 47±4% of baseline in Control versus 45±4%, 40±3%, and 42±3% in Lactate, Lact5min, and LactHyper (p=ns). LVEDP and CF were comparable across the groups. Ventricular arrhythmias occurred in 44%, 33%, 40%, and 50% of hearts, respectively (p=ns). Troponin and CK levels were similar (p=ns) between Controls and Lactate treated hearts. Mitochondrial functions, which were significantly impaired by CA, did not differ significantly between the two groups.
Conclusion:
Lactate administration did not improve post-CA myocardial function and was not deleterious. These findings suggest that the in vivo benefits of lactate administration are unlikely due to direct myocardial effects.
