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European Heart Journal 1983 4(6):406-414;
Copyright © 1983 by the European Society of Cardiology.
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© 1983, by the European Society of Cardiology

The effect of verapamil on myocardial exchange of free fatty acids, citrate, lactate and glucose in coronary artery disease

J.P. BAGGER, T. TOFTEGAARD NIELSEN and P. HENNINGSEN

Department of Cardiology, Aarhus Kommunehospital, and Departments of Internal Medicine III and Clinical Chemistry Aarhus Amtssygehus, DK-8000 Aarhus, Denmark

Received 15 December 1981; revised 8 September 1982; .

Requests for reprints to: Jens Peder Bagger, MD, Department of Cardiology, Aarhus Kommunehospital, DK-8000 Aarhus C, Denmark.

Abstract

Twelve patients with coronary artery stenosis (> 50% diameter reduction) underwent two identical periods of atrial pacing before and after i. v. verapamil (0.1 mg/kg). Myocardial exchanges of free fatty acids (FFA), citrate, lactate and glucose were evaluated from measurements of arterio-coronary sinus differences (n = 12) and coronary sinus blood flow (CSBF) (n = 9). Before verapamil 11 patients developed angina. Verapamil abolished pain in seven and improved pacing time to angina in four patients. After verapamil, aortic pressure decreased (P < 0.05), while the rate pressure product remained unchanged during rest and pacing. Verapamil decreased CSBF by 20% (P<0.05) during pacing, and increased oxygen extraction both during pacing and recovery. During pacing verapamil increased net FFA extraction (P<0.01) and uptake (1 to 8 µmol/min P<0.05), and decreased glucose extraction (P<0.05) and uptake (22 to 11 µmol/ min P< 0.02. Verapamil increased myocardial citrate release during pacing (P < 0.05), suggesting a citrate inhibition of glycolysis as a possible mechanism of the inhibited glucose uptake. During pacing, verapamil reduced lactate release in seven patients (P<0.05) and decreased lactate extraction in five patients (P<0.05). The results suggest that verapamil mediates its beneficial effect on pacing-induced angina, in part by changing substrate utilization of the ischaemic myocardium in man towards that of normal heart.

Key Words: Verapamil • pacing-induced angina • myocardial metabolism • free fatty acids • citrate • lactate • glucose


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