Substrate effects in the post-ischemic myocardium

A study was undertaken to examine the effects of glucose versus pyruvate as the sole substrate following severe myocardial ischemia. Glycolysis usually contributes only a small amount to total ATP production and may be rate limiting in providing tricarboxcylic acid (TCA) cycle substrates. Consequently, pyruvate may be a more effective substrate by bypassing glycolysis to feed directly to the TCA cycle and oxidative phosphorylation. Isolated rat hearts were studied in a retrograde (Langendorff) perfusion apparatus while in an NMR spectrometer. Rate pressure product (RPP), myocardial oxygen consumption (MVO₂), and the unidirectional P_i → ATP rate were measured in control and postischemic hearts with or without the inotrope dobutamine. The unidirectional P_i → ATP rate was higher in the glucose than the pyruvate hearts and the difference increased further postischemia. This increase over that of the pyruvate hearts has been attributed to a glycolytic component of ATP metabolism. Oxygen consumption was higher in pyruvate hearts at equivalent levels of performance. It thus appears that the glycolysis rate is significant and may be elevated following severe myocardial ischemia. Perfusion with pyruvate requires increased rates of oxidative phosphorylation to make up for the loss of glycolytically produced ATP. Optimal postischemic substrate delivery may require several compounds, one of which should be glucose.