Oxygen Demand-Supply Relationship in Peripheral Tissues as a Therapeutic Indicator in Acute Myocardial Infarction with Advanced Heart Failure

Abstract

Oxygen demand-supply relationships in peripheral tissues were studied in 14 patients who had acute myocardial infarction with advanced pump failure. Seven patients with acute myocardial infarction but without pump failure were studied as a control. In all patients, a Swan-Ganz catheter and a radial arterial cannula were inserted for the purpose of hemodynamic monitoring, and arterial and mixed venous blood were sampled. Initially, oxygen delivery (DO₂) (p < 0.01) was lower, and oxygen extraction ratio (OER) (p < 0.001) and oxygen tension at 50% saturation (P₅₀) (p < 0.01) were higher in patients with pump failure than in the controls. During the therapeutic course, with an increase in the cardiac index and DO₂, oxygen uptake (VO₂) did not change but OER (p < 0.001) and P₅₀ (p < 0.01) significantly decreased in 6 survivors with pump failure. In contrast, an increased VO₂ (p < 0.01) and no change of OER and P₅₀ were observed in 8 non-survivors with pump failure. These results suggest that reversibility of oxygenokinetics might be an important factor for recovery from critical heart failure.

Interrelationship between oxygen‐related variables in patients with acute myocardial infarction: an interpretative review

“…Cardiogenic shock developed in at least 153 patients (33AE8%); this high incidence is consistent with the large number of reviewed reports dealing only with this syndrome (Lichtman et al, 1974;da Luz et al, 1975;Astiz et al, 1988;Jorge, 1989;Creamer et al, 1990;Kirschenbaum et al, 2000;Lim et al, 2003). Some patients with cardiogenic shock are probably missing because of an unclear differentiation from advanced heart failure syndromes in several reports (Sumimoto et al, 1989(Sumimoto et al, , 1991Inoue et al, 1993). The overall mortality rate was 29% (125 out of 430), excluding the Lim et al (prior to death) series (Lim et al, 2003) and two other studies where the mortality rate was not specified (Lichtman et al, 1974;Utoh et al, 1999) (Table 2).…”

“…Some patients with cardiogenic shock are probably missing because of an unclear differentiation from advanced heart failure syndromes in several reports (Sumimoto et al. , 1989, 1991; Inoue et al. , 1993).…”

“…, 1974; Sumimoto et al. , 1989, 1991; Inoue et al. , 1993) to critically low values near to 100 ml min −1 m −2 (da Luz et al.…”

“…Oxygen delivery was below 300 ml min )1 m )2 in seven reports and above 300 ml min )1 m )2 in five reports. Oxygen uptake varied from values above 150 ml min )1 m )2 (Lichtman et al, 1974;Sumimoto et al, 1989Sumimoto et al, , 1991Inoue et al, 1993) to critically low values near to 100 ml min )1 m )2 (da Luz et al, 1975;Jorge, 1989;Creamer et al, 1990;Lim et al, 2003) ( Table 2).…”

“…Oxygen metabolism-related variables between survivors and non-survivors were examined in four reports during the first 24 h of AMI (da Luz et al, 1975;Sumimoto et al, 1989Sumimoto et al, , 1991Inoue et al, 1993). Taking an average of this data, we found that non-survivors (n = 48) exhibited significantly lower IDO 2 than survivors (n = 125) (355 ± 130 versus 524 ± 158 ml min )1 m )2 ; P = 0AE000) but higher O 2 -ER (0AE43 ± 0AE06 versus 0AE31 ± 0AE14%; P = 0AE000) and higher lactate levels (4AE01 ± 3 versus 1AE6 ± 0AE99 P = 0AE000).…”