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Ann Thorac Surg 1992;54:1151-1158
© 1992 The Society of Thoracic Surgeons

Articles

Influence of β 1-blockade on myocardial substrates early after a coronary operation

Örjan Wesslén, MD*, Jan van der Linden, MD, Rolf Ekroth, MD, Per-Olof Joachimsson, MD, Lars Nordgren, MD, Sven-Olov Nyström, MD, Gunnar Ronquist, MD, Hans Tydén, MD

Departments of Thoracic and Cardiovascular Surgery, Anesthesiology, Clinical Physiology, and Clinical Biochemistry, University Hospital, Uppsala, Sweden

Accepted for publication March 31, 1992.

* Address reprint requests to Dr Wesslén, Department of Thoracic and Cardiovascular Surgery, University Hospital, S-751 85 Uppsala, Sweden.

A high adrenergic strain during reperfusion after ischemia impedes functional recovery. Conversely, adrenergic blockade may be beneficial during reperfusion. This study was undertaken to find out if early postoperative high-dose infusion of the selective β 1-blocking agent metoprolol tartrate has additional effects on metabolic variables related to myocardial energy supply/demand balance compared with those obtained with a late preoperative oral dose. The study included 21 male patients undergoing coronary bypass grafting. All patients received an oral dose of metoprolol before the operation. After the operation, patients were randomized to a control group or a group receiving intravenous infusion of metoprolol. Myocardial uptake of oxygen and substrates was determined before and during atrial pacing. Metoprolol reduced arterial concentrations of free fatty acids, reduced myocardial uptake of free fatty acids, and enhanced myocardial uptake of lactate. During paced tachycardia, the metoprolol concentration correlated negatively with myocardial uptake of free fatty acids (r = –0.80; p < 0.001) and positively with myocardial uptake of lactate (r = 0.53; p < 0.05). It is concluded that postoperative infusion of metoprolol induces myocardial metabolic changes compatible with an improved energy supply/demand balance.




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