Circulation, Vol 66, 554-561, Copyright © 1982 by American Heart Association
TR Vrobel, CR Jorgensen and RJ Bache
To determine the value of lactate and the adenosine metabolites inosine and
hypoxanthine as indicators of myocardial ischemia, we measured the levels
of these metabolites in arterial and coronary sinus blood of nine
chronically instrumented dogs subjected to exercise stress before and
during reversible circumflex coronary artery occlusion. The degree of
circumflex bed hypoperfusion was measured by 15-mu microspheres and the
reduction in circumflex coronary flow was measured with a proximal flow
probe. Adenosine metabolites, although below the level of accurate
detection in our laboratory in arterial blood (i.e., 0.5 microM/l), were
detected in coronary sinus blood (range 2.7--18.7 microM/l) in 26 of 33
studies with partial circumflex occlusion when circumflex flow was reduced
to less than 80% of that seen during exercise without occlusion and when
only subendocardial perfusion was reduced. Global left ventricular flow and
transmural flow in nonischemic beds did not correlate with positive
studies. Myocardial lactate extraction was a less accurate test for
determining circumflex bed hypoperfusion. Thus, myocardial production of
adenosine metabolites is a sensitive qualitative test of exercise-induced
ischemia responding to a modest fall in coronary flow when only
subendocardial hypoperfusion is present.
ARTICLES
Myocardial lactate and adenosine metabolite production as indicators of exercise-induced myocardial ischemia in the dog
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