Intracoronary pyruvate in cardiogenic shock as an adjunctive therapy to catecholamines and intra-aortic balloon pump shows beneficial effects on hemodynamics

Abstract

Pyruvate was shown to increase cardiac performance in isolated human and animal myocardium and in patients with chronic heart failure. We sought to investigate the effects of pyruvate in acute heart failure. Patients presenting with cardiogenic shock because of acute myocardial infarction were subjected to standard care with primary PCI and intra-aortic balloon pump (IABP). Then, a Swan-Ganz catheter was placed in the pulmonary artery and hemodynamics was analyzed before, during and after intracoronary administration of 300 mmol/L pyruvate (360 ml/h). Pyruvate induced a significant increase in cardiac index (CI 2.23 +/- A 0.53 vs. 1.95 +/- A 0.45 L min(-1) m(-2); p < 0.05), stroke volume index (SVI, 29 +/- A 6 vs. 26 +/- A 5 mL m(-2); p < 0.05), and mean systemic arterial pressure (mean SAP, 95 +/- A 9 vs. 87 +/- A 9 mmHg; p < 0.05), whereas heart rate did not significantly change. The effects occurred rapidly within 30 min and were reversible within 10 min. Intracoronary pyruvate might show beneficial effects in severe acute heart failure in addition to treatment with catecholamines and IABP. These effects should be further investigated in randomized controlled trials.