Myocardial metabolic studies in prolapsing mitral leaflet syndrome

Patients with prolapsing mitral leaflet syndrome (PML) frequently have chest pain of undetermined etiology. Twenty-three patients with PML underwent cardiac hemodynamic, angiographic, and metabolic studies. The latter were performed during control spontaneous heart rate and tachycardia by right atri...

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Bibliographic Details
Published in:Circulation (New York, N.Y.) N.Y.), 1975-12, Vol.52 (6), p.1105-1110
Main Authors: Natarajan, G, Nakhjavan, F K, Kahn, D, Yazdanfar, S, Sahibzada, W, Khawaja, F, Goldberg, H
Format: Article
Language:English
Subjects:
Adult
Aged
Female
Hemodynamics
Humans
Lactates - metabolism
Male
Mathematics
Middle Aged
Mitral Valve Insufficiency - metabolism
Myocardium - metabolism
Oxygen Consumption
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Summary:Patients with prolapsing mitral leaflet syndrome (PML) frequently have chest pain of undetermined etiology. Twenty-three patients with PML underwent cardiac hemodynamic, angiographic, and metabolic studies. The latter were performed during control spontaneous heart rate and tachycardia by right atrial pacing. Myocardial supply-demand ratio (DPTI:SPTI) was estimated from the planimetric integration of the diastolic area (diastolic pressure time index = DPTI) and systolic area (systolic pressure time index = SPTI) of the central aortic pressure. Chest pain during pacing occurred in five patients. In two patients, it was associated with ST depression typical of ischemia on the electrocardiogram. Myocardial lactate abnormalities (lactate production or less than 10% extraction) occurred in seven patients during pacing tachycardia and was present in two patients during control state. DPTI:SPTI ratio during control state was 1.22 (+/- 0.07 SE) and decreased to 0.85 (+/- 0.05 SE) during pacing tachycardia. It is concluded that the myocardial lactate abnormalities in PML, which were present in approximately 30% of the patients in the present series, are most likely due to myocardial hypoxia. Whether or not the hypoxia is secondary to "small vessel disease" is not elucidated by this study.
ISSN:0009-7322
1524-4539
DOI:10.1161/01.cir.52.6.1105