Functional Recovery of Chronic Ischemic Myocardium after Surgical Revascularization Correlates with Magnitude of Oxidative Metabolism

Abstract

Background: The purpose of this study was to validate myocardial microdialysis measurements in patients after myocardial infarction with or without associated postoperative functional recovery in order to develop a highly sensitive tool for real-time in vivo detection of microcellular disorder during cardiac operations. Methods: In 20 patients undergoing coronary artery bypass grafting, microdialysis catheters were implanted into scar or hibernating segments detected by means of magnetic resonance imaging, and into a vital area of the right ventricle (control). Myocardial glucose, lactate and pyruvate were analyzed perioperatively. Myocardial ethanol washout was measured as a sign of recovered local blood flow. Results: After surgical revascularization, improvement of wall motion was found in all hibernating segments compared to the scar segments paralleling an increased glucose delivery to the tissue and increased myocardial tissue flow. The myocardial glucose/lactate ratio and pyruvate also showed significantly higher values. Microdialytic measurements of the viable segments were comparable with those of the right ventricle. Conclusions: Our results indicate that microdialysis measurements parallel magnetic resonance imaging findings in patients with revascularization of chronic ischemic myocardium with dyskinetic segments. The metabolism of those segments is characterized by a significantly increased tissue flow, an increased utilization of glucose and a better oxidative nutrition.

Detection of myocardial ischaemia using surface microdialysis on the beating heart

“…This application lowers the risk for bleeding complications compared to when probes are placed and removed from the myocardium, though clinical reports of microdialysis probes from the heart have not described complications (Bahlmann et al. , 2004; Pöling et al. , 2007a, 2008).…”

“…There are several advantages to a surface position of a sampling probe. This application lowers the risk for bleeding complications compared to when probes are placed and removed from the myocardium, though clinical reports of microdialysis probes from the heart have not described complications (Bahlmann et al, 2004;Pöling et al, 2007aPöling et al, , 2008. The surface approach might allow probe placement and sampling even on thin-walled organs including for example the heart atrial muscle, where the intramyocardial approach is not practical.…”

“…Microdialysis has shown promise for clinical myocardial metabolic sampling (Kennergren et al. , 2003; Pöling et al. , 2007a,b, 2008) but is more frequently used in experimental settings.…”