PMID- 28159812
OWN - NLM
STAT- MEDLINE
DCOM- 20170728
LR  - 20200930
IS  - 1522-1539 (Electronic)
IS  - 0363-6135 (Print)
IS  - 0363-6135 (Linking)
VI  - 312
IP  - 4
DP  - 2017 Apr 1
TI  - Right ventricular metabolism during venoarterial extracorporeal membrane 
      oxygenation in immature swine heart in vivo.
PG  - H721-H727
LID - 10.1152/ajpheart.00835.2016 [doi]
AB  - Venoarterial extracorporeal membrane oxygenation (VA-ECMO) provides hemodynamic 
      rescue for patients encountering right or left ventricular (RV or LV) 
      decompensation, particularly after surgery for congenital heart defects. ECMO, 
      supported metabolically by parenteral nutrition, provides reductions in 
      myocardial work and energy demand and, therefore, enhances functional recovery. 
      The RV must often assume systemic ventricular pressures and function on weaning 
      from VA-ECMO. However the substrate utilization responses of the RV to VA-ECMO or 
      stimulation are unknown. We determined RV and LV substrate utilization response 
      to VA-ECMO in immature swine heart. Mixed-breed male Yorkshire pigs (33-49 days 
      old) underwent normal pressure volume loading (control, n = 5) or were unloaded 
      by VA-ECMO (ECMO, n = 10) for 8 h. Five pigs with ECMO received intravenous 
      thyroid hormone [triiodothyronine (T(3))] to alter substrate utilization. Carbon 
      13 ((13)C)-labeled substrates (lactate and medium-chain and long-chain fatty 
      acids) were systemically infused as metabolic tracers. Analyses by nuclear 
      magnetic resonance showed that both ventricles have similar trends of fractional 
      (13)C-labeled substrate contributions to the citric acid cycle under control 
      conditions. VA-ECMO produced higher long-chain fatty acids and lower lactate 
      contribution to the citric acid cycle via inhibition of pyruvate dehydrogenase, 
      whereas T(3) promoted lactate metabolism in both ventricles. However, these 
      metabolic shifts were smaller in RV, and RV fatty acid contributions showed 
      minimal response to perturbations. Furthermore, VA-ECMO and T(3) also achieved 
      high [phosphocreatine]/[ATP] and low [NADH]/[NAD(+)] in LV but not in RV. These 
      data suggest that the RV shows decreased ability to modify substrate utilization 
      and achieve improvements in energy supply/demand during VA-ECMO.NEW & NOTEWORTHY 
      We showed that the right ventricle unloaded by venoarterial extracorporeal 
      membrane oxygenation (VA-ECMO) has diminished capacity to alter substrate 
      utilization compared with the left ventricle. This decrease in metabolic 
      flexibility contributes to the inability to increase high-energy phosphate 
      reserves during myocardial rest by VA-ECMO.
CI  - Copyright (c) 2017 the American Physiological Society.
FAU - Kajimoto, Masaki
AU  - Kajimoto M
AD  - Center for Integrative Brain Research, Seattle Children's Research Institute, 
      Seattle, Washington.
FAU - Ledee, Dolena R
AU  - Ledee DR
AD  - Center for Integrative Brain Research, Seattle Children's Research Institute, 
      Seattle, Washington.
FAU - Isern, Nancy G
AU  - Isern NG
AD  - Environmental Molecular Sciences Laboratory, Pacific Northwest National 
      Laboratories, Richland, Washington; and.
FAU - Portman, Michael A
AU  - Portman MA
AD  - Center for Integrative Brain Research, Seattle Children's Research Institute, 
      Seattle, Washington; michael.portman@seattlechildrens.org.
AD  - Division of Cardiology, Department of Pediatrics, University of Washington, 
      Seattle, Washington.
LA  - eng
GR  - K01 HL120886/HL/NHLBI NIH HHS/United States
GR  - R01 FD004362/FD/FDA HHS/United States
PT  - Journal Article
DEP - 20170203
PL  - United States
TA  - Am J Physiol Heart Circ Physiol
JT  - American journal of physiology. Heart and circulatory physiology
JID - 100901228
RN  - 0 (Fatty Acids)
RN  - 0 (Pyruvate Dehydrogenase Complex)
RN  - 020IUV4N33 (Phosphocreatine)
RN  - 06LU7C9H1V (Triiodothyronine)
RN  - 0U46U6E8UK (NAD)
RN  - 33X04XA5AT (Lactic Acid)
RN  - 8L70Q75FXE (Adenosine Triphosphate)
SB  - IM
MH  - Adenosine Triphosphate/metabolism
MH  - Animals
MH  - Energy Metabolism/physiology
MH  - *Extracorporeal Membrane Oxygenation
MH  - Fatty Acids/metabolism
MH  - Heart/*physiology
MH  - Heart Ventricles/diagnostic imaging/*metabolism
MH  - Hemodynamics/physiology
MH  - Lactic Acid/metabolism
MH  - Magnetic Resonance Spectroscopy
MH  - Male
MH  - Myocardium/*metabolism
MH  - NAD/metabolism
MH  - Phosphocreatine/metabolism
MH  - Pyruvate Dehydrogenase Complex/metabolism
MH  - Swine
MH  - Triiodothyronine/pharmacology
PMC - PMC5407156
OTO - NOTNLM
OT  - cardiac metabolism
OT  - extracorporeal circulation
OT  - pediatrics
OT  - thyroid hormone
EDAT- 2017/02/06 06:00
MHDA- 2017/07/29 06:00
PMCR- 2018/04/01
CRDT- 2017/02/05 06:00
PHST- 2016/12/19 00:00 [received]
PHST- 2017/01/17 00:00 [revised]
PHST- 2017/01/29 00:00 [accepted]
PHST- 2017/02/06 06:00 [pubmed]
PHST- 2017/07/29 06:00 [medline]
PHST- 2017/02/05 06:00 [entrez]
PHST- 2018/04/01 00:00 [pmc-release]
AID - ajpheart.00835.2016 [pii]
AID - H-00835-2016 [pii]
AID - 10.1152/ajpheart.00835.2016 [doi]
PST - ppublish
SO  - Am J Physiol Heart Circ Physiol. 2017 Apr 1;312(4):H721-H727. doi: 
      10.1152/ajpheart.00835.2016. Epub 2017 Feb 3.