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J Thorac Cardiovasc Surg 1996;112:1468-1477
© 1996 Mosby, Inc.
SURGERY FOR ACQUIRED HEART DISEASE |
Suppported by grants from the Swedish Heart Lung Foundation, The Swedish Society of Medicine, Östergötlands Läns Landsting, Linköping Heart Center and the University of Linköping.
Received for publication Jan. 18, 1996 Revisions requested March 1, 1996; revisions received June 5, 1996 Accepted for publication June 17, 1996. Address reprint requests to Dr. Rolf Svedjeholm, Department of Cardiothoracic Surgery, University Hospital, S-581 85 Linköping, Sweden.
Abstract
Amino acids, particularly glutamate, have been proposed to play an important role in the recovery of cardiac oxidative metabolism after ischemia. In this investigation, the metabolic and hemodynamic effects of glutamate infusion after coronary operations were studied. From 220 to 240 ml 0.1 mol/L L-glutamic acid solution was infused in 10 patients during 1 hour starting 2 hours after operation. A control group of 10 patients received an infusion of 240 ml saline solution. During glutamate infusion, there were significant increases in the uptake of glutamate (from 0.7 ± 0.2µmol/min in the basal state to a peak of 5.7 ± 1.2µmol/min at 20 minutes) and lactate (from 4.9 ± 2.0µmol/min in the basal state to 14.1 ± 4.4µmol/min at 60 minutes; p < 0.01), whereas the uptake and release of other substrates remained essentially unaffected. Arterial glutamate levels (in whole blood) increased from 103 ± 10µmol/L to 394 ± 20µmol/L at 60 minutes. Thirty minutes after discontinuation of the glutamate infusion, arterial levels had decreased to 129 ± 17µmol/L. The markedly improved utilization of lactate and the unchanged release of alanine together suggest that the oxidative metabolism of the heart was stimulated by glutamate. The metabolic changes were associated with improved myocardial performance. Left ventricular stroke work index increased from 26.8 ± 2.1 gm · beat-1 · m-2 body surface area to 31.3 ± 3.1 gm · beat-1 · m-2 body surface area during glutamate infusion. Metabolic support with amino acids may provide a means to improve recovery of metabolic and hemodynamic function of the heart early after cardiac operations. (J THORACCARDIOVASCSURG1996;112:1468-77)
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