Haemodynamic effects of intracoronary pyruvate in patients with congestive heart failure: an open study

Background Pyruvate, as an intermediate in the Krebs cycle, is an important source of energy for myocardium and improves contractility of normal, hypoxic, and postischaemic animal myocardium. We investigated the effect of intracoronary pyruvate in patients with congestive heart failure. Methods Haemodynamic measurements were done in eight patients with dilated cardiomyopathy after two 15 min infusions of pyruvate into the left main coronary artery and after saline washout of pyruvate. Findings There were no significant differences between the two pyruvate concentrations. Application of pyruvate resulted in a 23% increase in cardiac index (p<0·05), a 38% increase in stroke-volume index (p<0·05), and a 36% decrease in pulmonary capillary wedge pressure (p<0·05). Heart rate decreased significantly by 11%. Mean aortic pressure and systemic vascular resistance did not change. Most of the effects of pyruvate were reversed 15 min after the infusion stopped. Interpretation Pyruvate has the profile of a favourable inotropic substance. Other modes of administration need to be studied.