Transmural Distribution of Metabolic Abnormalities and Glycolytic Activity during Dobutamine Induced Demand Ischemia

摘要

The heterogeneity across the LV wall is characterized by higher rates of oxygen consumption, systolic thickening fraction, myocardial perfusion and lower energetic state in the subendocardial layers (ENDO). During dobutamine stimulation induced demand ischemia, the transmural distribution of energy demand and metabolic markers of ischemia are not known. In this study, hemodynamics, transmural high energy phosphate (HEP) and 2-deoxyglucose-6-phosphate (2DGP) levels and myocardial blood flow (MBF) were determined under basal conditions (B), during dobutamine infusion (DOB: 20 μg/kg/min iv.), and during coronary stenosis+DOB+2-deoxy-glucose (2DG) infusion. DOB increased rate pressure products (RPP) and MBF significantly without affecting subendocardial to subepicardial blood flow ratio (ENDO/EPI) or HEP levels. During coronary stenosis+DOB+2-deoxy-glucose (2DG) infusion RPP, ischemic zone (IZ) MBF and ENDO/EPI decreased significantly. IZ PCr/ATP decreased significantly (2.30 +/- 0.14, 2.06 +/- 0.13 and 2.04 +/- 0.11 to 1.77 +/- 0.12, 1.70 +/- 0.11 and 1.72 +/- 0.12; EPI, MID and ENDO, respectively) and 2DG6P accumulated in all layers as evidenced by the 2DG6P/PCr (0.55 +/- 0.12, 0.52 +/- 0.10 and 0.37 +/- 0.08; EPI, MID and ENDO respectively; p<0.05, EPI>ENDO). In the IZ the wet weight/dry weight ratio was significantly increased as compared to the normal zone (5.9 +/- 0.5 vs. 4.4 +/- 0.4; p<0.05). Thus, in stenotic perfused bed, during dobutamine induced high cardiac workstate, despite higher blood flow the subepicardial layers showed the greater metabolic changes that characterized by a shift toward higher carbohydrate metabolism suggesting a homeostatic responses to high cardiac workstate is characterized by more glucose utilization in energy metabolism.