MYOCARDIAL LACTATE METABOLISM AT REST AND DURING EXERCISE IN ISCHEMIC HEART DISEASE

Cardiac dynamics and myocardial extraction of oxygen and lactate were investigated at rest in subjects with normal coronary arteries and in patients with coronary heart disease. Coronary artery disease was considered significant when there was obstruction or more than 50 per cent narrowing of one or more coronary arteries. Half of the patients were also studied during moderate exercise. The hemodynamic findings were almost comparable in all cases. On exercise, in patients with significant coronary disease, there was evidence of abnormal left ventricular function, and increases in cardiac index were mediated through a much higher left ventricular end-diastolic pressure. Coronary arteriovenous difference and the myocardial extraction of oxygen were normal at rest and unchanged on exercise in all cases. Marked rise in the arterial level and a significant increase in the arteriovenous difference of lactate were present in all cases. The extraction ratio of lactate by the myocardium remained normal and increased only slightly in control subjects. However, this ratio increased to normal levels during exercise in all patients with significant coronary artery disease. Possible explanations for the increased coronary arteriovenous difference and myocardial extraction ratio of lactate on exercise in these patients are discussed. © 1969.