Improved systolic and diastolic myocardial function with intracoronary pyruvate in patients with congestive heart failure

Abstract

Background: Pyruvate increases myocardial performance in isolated myocardium and improves hemodynamics in patients with congestive heart failure. Aims: To investigate the influence of pyruvate on detailed parameters of systolic and diastolic left ventricular (LV) function. Methods and Results: In patients with heart failure due to dilated cardiomyopathy (LVEF 30 +/- 4%, n = 9) pyruvate was infused intracoronarily. LV function was analysed before, during and after application of different pyruvate concentrations using a LV-micromanometer catheter. LV volumes were determined using cine ventriculography. Pyruvate increased maximum rate of LV isovolumic pressure rise (Peak + dP/dt) from 802 +/- 106 to 1125 +/- 103 mmHg/s (P < 0.05). Left ventricular end-diastolic pressure declined in parallel from 17 +/- 2 to 12 +/- 2 mmHg (P < 0.05) and heart rate decreased from 79 +/- 4 to 72 +/- 5 min(-1) (P < 0.05). Stroke volume index increased from 34 +/- 4 to 43 +/- 6 ml/m(2) (P < 0.05), end-diastolic LV volume remained unchanged. thus left ventricular ejection fraction increased with pyruvate from 30 +/- 4 to 39 +/- 4% (P < 0.05). Maximum rate of LV isovolumic pressure decline (Peak - dP/dt) was significantly increased with pyruvate (from 794 +/- 94 to 980 +/- 108 mmHg/s; P < 0.05) and mean arterial pressure increased from 80 +/- 5 to 88 +/- 4 mmHg (P < 0.05). Discontinuation of pyruvate resulted in immediate reversibility of its effects. Conclusion: Intracoronary pyruvate improves systolic and diastolic myocardial function and increases ejection fraction without increasing heart rate. Pyruvate thus exhibits the profile of a favourable inotropic agent, however, further investigation for the treatment of patients with acute heart failure is mandatory. (C) 2003 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.