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The Journal of Thoracic and Cardiovascular Surgery, Vol 99, 1063-1073, Copyright © 1990 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
S Svensson, R Svedjeholm, R Ekroth, I Milocco, F Nilsson, KG Sabel and G William- Olsson
In a controlled, randomized study the myocardial uptake/release of
individual free fatty acids, glucose, lactate, pyruvate, alanine, and
glycerol was studied 1 hour after completion of coronary operations. The
effects of insulin were evaluated by means of a hyperinsulinemic "clamp"
technique. No significant uptake of free fatty acids was found despite
markedly elevated arterial concentrations (mean +/- standard error of the
mean, 2.01 +/- 0.19 mmol.L-1), oleic acid, together with palmitic and
linoleic acid, constituting 80% of the total plasma free fatty acid level.
Insulin treatment (1 unit.kg bw-1.hr-1) prevented a further increase of the
plasma free fatty acid level, observed concomitantly in the control group.
Insulin affected all individual free fatty acids similarly. Changes in
plasma free fatty acid levels occurring during the study and the
corresponding myocardial uptake correlated (rS = 0.50 to 0.81). No
significant uptake or release of glucose, lactate pyruvate, and glycerol
occurred, whereas a myocardial release of alanine was seen. The heart and
the concomitant leg uptake/release of glucose (rS = 0.40, p less than 0.05)
and lactate (rS = 0.67, p less than 0.01) correlated. A substantial uptake
of glucose was achieved and a more positive myocardial balance was obtained
for alanine, lactate, and pyruvate with insulin. The changes in heart and
the concomitant leg uptake/release correlated (glucose, rS = 0.62, p less
than 0.01; lactate, rS = 0.64, p less than 0.01; pyruvate, rS = 0.71, p
less than 0.01). It is concluded that the myocardial uptake of substrates
during the first hours after coronary surgery is markedly abnormal with no
uptake of free fatty acids or carbohydrates. These changes can be explained
to some extent by the insulin resistance of trauma metabolism and can be
modified by insulin treatment.
ARTICLES
Trauma metabolism and the heart. Uptake of substrates and effects of insulin early after cardiac operations
Department of Thoracic and Cardiovascular Surgery, Sahlgrenska Hospital, Goteborg, Sweden.
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