Active downregulation of myocardial energy requirements during prolonged moderate ischemia in swine

A. E. Arai, G. A. Pantely, C. G. Anselone, J. Bristow, J. D. Bristow

Research output: Contribution to journalArticlepeer-review

118 Scopus citations


We studied the effects of rapid atrial pacing during the final 10 minutes of a 70-minute, 31% reduction in coronary blood flow in anesthetized swine to understand the significance of apparent metabolic improvements during the initial 60 minutes of segmental ischemia. Within 5-10 minutes of ischemia, subendocardial phosphocreatine (PCr) and ATP were depleted to 47% and 63% of control, respectively; lactate accumulated within the subendocardium to 300% of control; and net arteriovenous lactate production occurred. Despite continued ischemia and no significant changes in the external determinants of myocardial oxygen consumption, by 60 minutes subendocardial PCr and lactate contents returned to near control levels and there was net arteriovenous lactate consumption. Ischemic left ventricular wall thickening and ATP levels remained depressed throughout the experiment. Atrial pacing during the final 10 minutes of ischemia again resulted in depletion of PCr and lactate production. Since the myocardium was capable of hydrolyzing PCr in response to atrial pacing at 60 minutes of ischemia, we conclude it was capable of hydrolyzing PCr during the period of constant ischemia when instead it was accumulating PCr. We propose the ischemic myocardium downregulates regional energy requirements below blood flow-limited rates of energy production during ischemia. This appears to be an active adaptation to ischemia and not a result of passive damage or cellular injury.

Original languageEnglish (US)
Pages (from-to)1458-1469
Number of pages12
JournalCirculation research
Issue number6
StatePublished - 1991
Externally publishedYes


  • ATP
  • Hibernation
  • Lactate
  • Metabolism
  • Phosphocreatine

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine


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