phosphocreatine and Coronary-Stenosis

The aim is to study influence of short-term episodes ischemic of myocardium in a combination with intravenous introduction of creatine phosphate on current of ischemic heart disease at the patients with distal stenoses of coronary arteries. We survey 86 patients, which were divided into two groups: basic, which are receiving neoton in a combination with ischemic training and control who are receiving standard antianginal therapy. The research proceeded within 5 years. The authentic improvement of tolerance to physical effort, quality of life, decrease anginal attacks and normalization systolic and diastolic cardiac function of the basic group is marked.

Topics: Adult; Aged; Cardiotonic Agents; Combined Modality Therapy; Coronary Stenosis; Ergometry; Exercise Therapy; Humans; Ischemic Preconditioning, Myocardial; Male; Middle Aged; Phosphocreatine; Physical Exertion; Quality of Life

The heterogeneity across the left ventricular wall is characterized by higher rates of oxygen consumption, systolic thickening fraction, myocardial perfusion, and lower energetic state in the subendocardial layers (ENDO). During dobutamine stimulation-induced demand ischemia, the transmural distribution of energy demand and metabolic markers of ischemia are not known. In this study, hemodynamics, transmural high-energy phosphate (HEP), 2-deoxyglucose-6-phosphate (2-DGP) levels, and myocardial blood flow (MBF) were determined under basal conditions, during dobutamine infusion (DOB: 20 microg x kg(-1) x min(-1) iv), and during coronary stenosis + DOB + 2-deoxyglucose (2-DG) infusion. DOB increased rate pressure products (RPP) and MBF significantly without affecting the subendocardial-to-subepicardial blood flow ratio (ENDO/EPI) or HEP levels. During coronary stenosis + DOB + 2-DG infusion, RPP, ischemic zone (IZ) MBF, and ENDO/EPI decreased significantly. The IZ ratio of creatine phosphate-to-ATP decreased significantly [2.30 +/- 0.14, 2.06 +/- 0.13, and 2.04 +/- 0.11 to 1.77 +/- 0.12, 1.70 +/- 0.11, and 1.72 +/- 0.12 for EPI, midmyocardial (MID), and ENDO, respectively], and 2-DGP accumulated in all layers, as evidenced by the 2-DGP/PCr (0.55 +/- 0.12, 0.52 +/- 0.10, and 0.37 +/- 0.08 for EPI, MID, and ENDO, respectively; P < 0.05, EPI > ENDO). In the IZ the wet weight-to-dry weight ratio was significantly increased compared with the normal zone (5.9 +/- 0.5 vs. 4.4 +/- 0.4; P < 0.05). Thus, in the stenotic perfused bed, during dobutamine-induced high cardiac work state, despite higher blood flow, the subepicardial layers showed the greater metabolic changes characterized by a shift toward higher carbohydrate metabolism, suggesting that a homeostatic response to high-cardiac work state is characterized by more glucose utilization in energy metabolism.

Topics: Adenosine Triphosphate; Animals; Coronary Circulation; Coronary Stenosis; Disease Models, Animal; Dobutamine; Dogs; Endocardium; Energy Metabolism; Glucose-6-Phosphate; Glycolysis; Hemodynamics; Lactic Acid; Magnetic Resonance Spectroscopy; Myocardial Ischemia; Myocardium; Oxygen Consumption; Pericardium; Phosphocreatine

We previously reported that 20% of women with chest pain but without obstructive coronary artery disease (CAD) had stress-induced reduction in myocardial phosphocreatine-adenosine triphosphate ratio by phosphorus-31 nuclear magnetic resonance spectroscopy (abnormal MRS), consistent with myocardial ischemia. The prognostic implications of these findings are unknown.. Women referred for coronary angiography for suspected myocardial ischemia underwent MRS handgrip stress testing and follow-up evaluation. These included (1) n=60 with no CAD/normal MRS, (2) n=14 with no CAD/abnormal MRS, and (3) n=352 a reference group with CAD. Cardiovascular events were death, myocardial infarction, heart failure, stroke, other vascular events, and hospitalization for unstable angina. Cumulative freedom from events at 3 years was 87%, 57%, and 52% for women with no CAD/normal MRS, no CAD/abnormal MRS, and CAD, respectively (P<0.01). After adjusting for CAD and cardiac risk factors, a phosphocreatine-adenosine triphosphate ratio decrease of 1% increased the risk of a cardiovascular event by 4% (P=0.02). The higher event rate in women with no CAD/abnormal MRS was primarily due to hospitalization for unstable angina, which is associated with repeat catheterization and higher healthcare costs.. Among women without CAD, abnormal MRS consistent with myocardial ischemia predicted cardiovascular outcome, notably higher rates of anginal hospitalization, repeat catheterization, and greater treatment costs. Further evaluation into the underlying pathophysiology and possible treatment options for women with evidence of myocardial ischemia but without CAD is indicated.

Topics: Adenosine Triphosphate; Aged; Angina, Unstable; Cardiac Catheterization; Cohort Studies; Coronary Angiography; Coronary Stenosis; Cost-Benefit Analysis; Disease-Free Survival; Female; Follow-Up Studies; Hand Strength; Health Care Costs; Heart Failure; Hospitalization; Humans; Life Tables; Magnetic Resonance Spectroscopy; Middle Aged; Myocardial Infarction; Myocardial Ischemia; Myocardium; Outcome Assessment, Health Care; Phosphocreatine; Prognosis; Risk Factors; Stroke; United States