Myocardial lactate metabolism in relation to preoperative regional wall motion and to early functional recovery after coronary revascularization
Objective: To evaluate myocardial lactate metabolism as a marker of functional status after surgical coronary revascularization. Design: Single-center, prospective, cohort study. Setting: Tertiary care teaching hospital. Participants: Fifty patients with stable angina, ejection fraction >0.40, un...
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| Veröffentlicht in: | Journal of cardiothoracic and vascular anesthesia 2003-08, Vol.17 (4), p.478-485 |
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| creator | Bortone, Franco Mazzoni, Maurizio Repossini, Alberto Campolo, Jonica Ceriani, Roberto Devoto, Emmanuela Parolini, Marina De Maria, Renata Arena, Vincenzo Parodi, Oberdan |
| description | Objective:
To evaluate myocardial lactate metabolism as a marker of functional status after surgical coronary revascularization.
Design:
Single-center, prospective, cohort study.
Setting:
Tertiary care teaching hospital.
Participants:
Fifty patients with stable angina, ejection fraction >0.40, undergoing coronary artery bypass surgery for multiple-vessel disease.
Measurements and main results:
Before (T1) and 30 minutes (T2) after coronary artery bypass grafting, the authors simultaneously sampled blood from artery and coronary sinus to determine myocardial lactate dynamics and performed transesophageal echocardiography (TEE) to assess segmental wall motion. Wall motion score index (WMSI) was calculated with an online/offline comparison. At T2, WMSI improved from 1.40 ± 0.31 to 1.17 ± 0.23 (
p = 0.0001). Preoperatively, 2 patterns of lactate balance were found: 39 patients were lactate extractors (17% ± 10%) and 11 were lactate producers (−11% ± 11%). At T2, lactate metabolism was shifted towards a pattern opposite to the baseline: delta lactate extraction was −8% ± 16% in extractors at T1 versus 7% ± 9% in producers at T1 (
p = 0.003). Changes in WMSI were not correlated with changes in lactate utilization. No single preoperative variable predicted postoperative WMSI or its changes from baseline. Cardiopulmonary bypass (CPB) time was the only significant predictor of postoperative lactate extraction by multivariate regression (
r = −0.46,
p = 0.001): at T2, patients in the highest CPB time quartile showed frank lactate production (−6% ± 13%) when compared with those in the lowest quartile (15% ± 11%,
p = 0.005). However, postoperative WMSI was similar in different CPB time groups.
Conclusions:
Myocardial lactate metabolism pattern is not associated with functional status before and early after successful coronary revascularization. CPB time was the only significant predictor of postoperative lactate extraction. Measurement of lactate does not appear to be a valuable tool to assess the coupling of myocardial regional function and metabolism in the setting of coronary artery surgery and mild-to-moderate functional impairment. |
| doi_str_mv | 10.1016/S1053-0770(03)00153-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_73640713</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S1053077003001538</els_id><sourcerecordid>73640713</sourcerecordid><originalsourceid>FETCH-LOGICAL-c391t-57d9106c5e7327e160aaac9df56a821e748931a592e2e9bacef5205279b2c9f83</originalsourceid><addsrcrecordid>eNqFkc-O1DAMxiMEYpeFRwDlAoJDIUknTXNCaMU_aREH4Bx5UhcFpc2QpIOGp-CRcWcG7ZGTY-dnf9Znxh5L8VIK2b36IoVuG2GMeC7aF0JIyvo77JKiavqNUnfp_Q-5YA9K-UGQ1NrcZxdS2a5XbXfJ_nw6JA95CBB5BF-hIp-wwjbFUCYeZp4xQg1p5jXxXca0w0z5HunjO5Wp7xfEyKd0hGAeVhAhxwMfl9nXE5PRpz3mA4exYuY-ZSpTmnEPxS8Rcvh9lHnI7o0QCz46xyv27d3br9cfmpvP7z9ev7lpfGtlbbQZrBSd12haZVB2AgC8HUbdQa8kmk1vWwnaKlRot-Bx1EpoZexWeTv27RV7dpq7y-nngqW6KRSPMcKMaSnOtN1GGNkSqE-gz6mUjKPb5TDR7k4Kt57CHU_hVp-doLiewq0CT84Cy3bC4bbr7D0BT88AOQBxzDD7UG45LXprpCHu9YlDsmMfMLviA84eh0CuVjek8J9V_gKhcamK</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>73640713</pqid></control><display><type>article</type><title>Myocardial lactate metabolism in relation to preoperative regional wall motion and to early functional recovery after coronary revascularization</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><creator>Bortone, Franco ; Mazzoni, Maurizio ; Repossini, Alberto ; Campolo, Jonica ; Ceriani, Roberto ; Devoto, Emmanuela ; Parolini, Marina ; De Maria, Renata ; Arena, Vincenzo ; Parodi, Oberdan</creator><creatorcontrib>Bortone, Franco ; Mazzoni, Maurizio ; Repossini, Alberto ; Campolo, Jonica ; Ceriani, Roberto ; Devoto, Emmanuela ; Parolini, Marina ; De Maria, Renata ; Arena, Vincenzo ; Parodi, Oberdan</creatorcontrib><description>Objective:
To evaluate myocardial lactate metabolism as a marker of functional status after surgical coronary revascularization.
Design:
Single-center, prospective, cohort study.
Setting:
Tertiary care teaching hospital.
Participants:
Fifty patients with stable angina, ejection fraction >0.40, undergoing coronary artery bypass surgery for multiple-vessel disease.
Measurements and main results:
Before (T1) and 30 minutes (T2) after coronary artery bypass grafting, the authors simultaneously sampled blood from artery and coronary sinus to determine myocardial lactate dynamics and performed transesophageal echocardiography (TEE) to assess segmental wall motion. Wall motion score index (WMSI) was calculated with an online/offline comparison. At T2, WMSI improved from 1.40 ± 0.31 to 1.17 ± 0.23 (
p = 0.0001). Preoperatively, 2 patterns of lactate balance were found: 39 patients were lactate extractors (17% ± 10%) and 11 were lactate producers (−11% ± 11%). At T2, lactate metabolism was shifted towards a pattern opposite to the baseline: delta lactate extraction was −8% ± 16% in extractors at T1 versus 7% ± 9% in producers at T1 (
p = 0.003). Changes in WMSI were not correlated with changes in lactate utilization. No single preoperative variable predicted postoperative WMSI or its changes from baseline. Cardiopulmonary bypass (CPB) time was the only significant predictor of postoperative lactate extraction by multivariate regression (
r = −0.46,
p = 0.001): at T2, patients in the highest CPB time quartile showed frank lactate production (−6% ± 13%) when compared with those in the lowest quartile (15% ± 11%,
p = 0.005). However, postoperative WMSI was similar in different CPB time groups.
Conclusions:
Myocardial lactate metabolism pattern is not associated with functional status before and early after successful coronary revascularization. CPB time was the only significant predictor of postoperative lactate extraction. Measurement of lactate does not appear to be a valuable tool to assess the coupling of myocardial regional function and metabolism in the setting of coronary artery surgery and mild-to-moderate functional impairment.</description><identifier>ISSN: 1053-0770</identifier><identifier>EISSN: 1532-8422</identifier><identifier>DOI: 10.1016/S1053-0770(03)00153-8</identifier><identifier>PMID: 12968236</identifier><language>eng</language><publisher>Philadelphia, PA: Elsevier Inc</publisher><subject>Aged ; Arteries - diagnostic imaging ; Arteries - metabolism ; Arteries - physiopathology ; Biological and medical sciences ; Biomarkers - analysis ; Blood Pressure - physiology ; Cardiopulmonary Bypass ; Coronary Artery Bypass ; coronary artery surgery ; Coronary Circulation - physiology ; Coronary Vessels - diagnostic imaging ; Coronary Vessels - metabolism ; Coronary Vessels - physiopathology ; Echocardiography ; Echocardiography, Transesophageal ; Female ; Heart Rate - physiology ; Humans ; lactate ; Lactic Acid - metabolism ; Male ; Medical sciences ; Middle Aged ; Multivariate Analysis ; Myocardial Contraction - physiology ; myocardial wall motion ; Myocardium - metabolism ; Myocardium - pathology ; Postoperative Period ; Predictive Value of Tests ; Prospective Studies ; Recovery of Function - physiology ; Statistics as Topic ; Stroke Volume - physiology ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the heart ; Time Factors ; transesophageal ; Treatment Outcome ; Vascular Resistance - physiology</subject><ispartof>Journal of cardiothoracic and vascular anesthesia, 2003-08, Vol.17 (4), p.478-485</ispartof><rights>2003 Elsevier Inc.</rights><rights>2004 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c391t-57d9106c5e7327e160aaac9df56a821e748931a592e2e9bacef5205279b2c9f83</citedby><cites>FETCH-LOGICAL-c391t-57d9106c5e7327e160aaac9df56a821e748931a592e2e9bacef5205279b2c9f83</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S1053077003001538$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=15089717$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/12968236$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bortone, Franco</creatorcontrib><creatorcontrib>Mazzoni, Maurizio</creatorcontrib><creatorcontrib>Repossini, Alberto</creatorcontrib><creatorcontrib>Campolo, Jonica</creatorcontrib><creatorcontrib>Ceriani, Roberto</creatorcontrib><creatorcontrib>Devoto, Emmanuela</creatorcontrib><creatorcontrib>Parolini, Marina</creatorcontrib><creatorcontrib>De Maria, Renata</creatorcontrib><creatorcontrib>Arena, Vincenzo</creatorcontrib><creatorcontrib>Parodi, Oberdan</creatorcontrib><title>Myocardial lactate metabolism in relation to preoperative regional wall motion and to early functional recovery after coronary revascularization</title><title>Journal of cardiothoracic and vascular anesthesia</title><addtitle>J Cardiothorac Vasc Anesth</addtitle><description>Objective:
To evaluate myocardial lactate metabolism as a marker of functional status after surgical coronary revascularization.
Design:
Single-center, prospective, cohort study.
Setting:
Tertiary care teaching hospital.
Participants:
Fifty patients with stable angina, ejection fraction >0.40, undergoing coronary artery bypass surgery for multiple-vessel disease.
Measurements and main results:
Before (T1) and 30 minutes (T2) after coronary artery bypass grafting, the authors simultaneously sampled blood from artery and coronary sinus to determine myocardial lactate dynamics and performed transesophageal echocardiography (TEE) to assess segmental wall motion. Wall motion score index (WMSI) was calculated with an online/offline comparison. At T2, WMSI improved from 1.40 ± 0.31 to 1.17 ± 0.23 (
p = 0.0001). Preoperatively, 2 patterns of lactate balance were found: 39 patients were lactate extractors (17% ± 10%) and 11 were lactate producers (−11% ± 11%). At T2, lactate metabolism was shifted towards a pattern opposite to the baseline: delta lactate extraction was −8% ± 16% in extractors at T1 versus 7% ± 9% in producers at T1 (
p = 0.003). Changes in WMSI were not correlated with changes in lactate utilization. No single preoperative variable predicted postoperative WMSI or its changes from baseline. Cardiopulmonary bypass (CPB) time was the only significant predictor of postoperative lactate extraction by multivariate regression (
r = −0.46,
p = 0.001): at T2, patients in the highest CPB time quartile showed frank lactate production (−6% ± 13%) when compared with those in the lowest quartile (15% ± 11%,
p = 0.005). However, postoperative WMSI was similar in different CPB time groups.
Conclusions:
Myocardial lactate metabolism pattern is not associated with functional status before and early after successful coronary revascularization. CPB time was the only significant predictor of postoperative lactate extraction. Measurement of lactate does not appear to be a valuable tool to assess the coupling of myocardial regional function and metabolism in the setting of coronary artery surgery and mild-to-moderate functional impairment.</description><subject>Aged</subject><subject>Arteries - diagnostic imaging</subject><subject>Arteries - metabolism</subject><subject>Arteries - physiopathology</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - analysis</subject><subject>Blood Pressure - physiology</subject><subject>Cardiopulmonary Bypass</subject><subject>Coronary Artery Bypass</subject><subject>coronary artery surgery</subject><subject>Coronary Circulation - physiology</subject><subject>Coronary Vessels - diagnostic imaging</subject><subject>Coronary Vessels - metabolism</subject><subject>Coronary Vessels - physiopathology</subject><subject>Echocardiography</subject><subject>Echocardiography, Transesophageal</subject><subject>Female</subject><subject>Heart Rate - physiology</subject><subject>Humans</subject><subject>lactate</subject><subject>Lactic Acid - metabolism</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Myocardial Contraction - physiology</subject><subject>myocardial wall motion</subject><subject>Myocardium - metabolism</subject><subject>Myocardium - pathology</subject><subject>Postoperative Period</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Recovery of Function - physiology</subject><subject>Statistics as Topic</subject><subject>Stroke Volume - physiology</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Surgery of the heart</subject><subject>Time Factors</subject><subject>transesophageal</subject><subject>Treatment Outcome</subject><subject>Vascular Resistance - physiology</subject><issn>1053-0770</issn><issn>1532-8422</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2003</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc-O1DAMxiMEYpeFRwDlAoJDIUknTXNCaMU_aREH4Bx5UhcFpc2QpIOGp-CRcWcG7ZGTY-dnf9Znxh5L8VIK2b36IoVuG2GMeC7aF0JIyvo77JKiavqNUnfp_Q-5YA9K-UGQ1NrcZxdS2a5XbXfJ_nw6JA95CBB5BF-hIp-wwjbFUCYeZp4xQg1p5jXxXca0w0z5HunjO5Wp7xfEyKd0hGAeVhAhxwMfl9nXE5PRpz3mA4exYuY-ZSpTmnEPxS8Rcvh9lHnI7o0QCz46xyv27d3br9cfmpvP7z9ev7lpfGtlbbQZrBSd12haZVB2AgC8HUbdQa8kmk1vWwnaKlRot-Bx1EpoZexWeTv27RV7dpq7y-nngqW6KRSPMcKMaSnOtN1GGNkSqE-gz6mUjKPb5TDR7k4Kt57CHU_hVp-doLiewq0CT84Cy3bC4bbr7D0BT88AOQBxzDD7UG45LXprpCHu9YlDsmMfMLviA84eh0CuVjek8J9V_gKhcamK</recordid><startdate>20030801</startdate><enddate>20030801</enddate><creator>Bortone, Franco</creator><creator>Mazzoni, Maurizio</creator><creator>Repossini, Alberto</creator><creator>Campolo, Jonica</creator><creator>Ceriani, Roberto</creator><creator>Devoto, Emmanuela</creator><creator>Parolini, Marina</creator><creator>De Maria, Renata</creator><creator>Arena, Vincenzo</creator><creator>Parodi, Oberdan</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20030801</creationdate><title>Myocardial lactate metabolism in relation to preoperative regional wall motion and to early functional recovery after coronary revascularization</title><author>Bortone, Franco ; Mazzoni, Maurizio ; Repossini, Alberto ; Campolo, Jonica ; Ceriani, Roberto ; Devoto, Emmanuela ; Parolini, Marina ; De Maria, Renata ; Arena, Vincenzo ; Parodi, Oberdan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c391t-57d9106c5e7327e160aaac9df56a821e748931a592e2e9bacef5205279b2c9f83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2003</creationdate><topic>Aged</topic><topic>Arteries - diagnostic imaging</topic><topic>Arteries - metabolism</topic><topic>Arteries - physiopathology</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - analysis</topic><topic>Blood Pressure - physiology</topic><topic>Cardiopulmonary Bypass</topic><topic>Coronary Artery Bypass</topic><topic>coronary artery surgery</topic><topic>Coronary Circulation - physiology</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Coronary Vessels - metabolism</topic><topic>Coronary Vessels - physiopathology</topic><topic>Echocardiography</topic><topic>Echocardiography, Transesophageal</topic><topic>Female</topic><topic>Heart Rate - physiology</topic><topic>Humans</topic><topic>lactate</topic><topic>Lactic Acid - metabolism</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Myocardial Contraction - physiology</topic><topic>myocardial wall motion</topic><topic>Myocardium - metabolism</topic><topic>Myocardium - pathology</topic><topic>Postoperative Period</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Recovery of Function - physiology</topic><topic>Statistics as Topic</topic><topic>Stroke Volume - physiology</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Surgery of the heart</topic><topic>Time Factors</topic><topic>transesophageal</topic><topic>Treatment Outcome</topic><topic>Vascular Resistance - physiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bortone, Franco</creatorcontrib><creatorcontrib>Mazzoni, Maurizio</creatorcontrib><creatorcontrib>Repossini, Alberto</creatorcontrib><creatorcontrib>Campolo, Jonica</creatorcontrib><creatorcontrib>Ceriani, Roberto</creatorcontrib><creatorcontrib>Devoto, Emmanuela</creatorcontrib><creatorcontrib>Parolini, Marina</creatorcontrib><creatorcontrib>De Maria, Renata</creatorcontrib><creatorcontrib>Arena, Vincenzo</creatorcontrib><creatorcontrib>Parodi, Oberdan</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiothoracic and vascular anesthesia</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bortone, Franco</au><au>Mazzoni, Maurizio</au><au>Repossini, Alberto</au><au>Campolo, Jonica</au><au>Ceriani, Roberto</au><au>Devoto, Emmanuela</au><au>Parolini, Marina</au><au>De Maria, Renata</au><au>Arena, Vincenzo</au><au>Parodi, Oberdan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Myocardial lactate metabolism in relation to preoperative regional wall motion and to early functional recovery after coronary revascularization</atitle><jtitle>Journal of cardiothoracic and vascular anesthesia</jtitle><addtitle>J Cardiothorac Vasc Anesth</addtitle><date>2003-08-01</date><risdate>2003</risdate><volume>17</volume><issue>4</issue><spage>478</spage><epage>485</epage><pages>478-485</pages><issn>1053-0770</issn><eissn>1532-8422</eissn><abstract>Objective:
To evaluate myocardial lactate metabolism as a marker of functional status after surgical coronary revascularization.
Design:
Single-center, prospective, cohort study.
Setting:
Tertiary care teaching hospital.
Participants:
Fifty patients with stable angina, ejection fraction >0.40, undergoing coronary artery bypass surgery for multiple-vessel disease.
Measurements and main results:
Before (T1) and 30 minutes (T2) after coronary artery bypass grafting, the authors simultaneously sampled blood from artery and coronary sinus to determine myocardial lactate dynamics and performed transesophageal echocardiography (TEE) to assess segmental wall motion. Wall motion score index (WMSI) was calculated with an online/offline comparison. At T2, WMSI improved from 1.40 ± 0.31 to 1.17 ± 0.23 (
p = 0.0001). Preoperatively, 2 patterns of lactate balance were found: 39 patients were lactate extractors (17% ± 10%) and 11 were lactate producers (−11% ± 11%). At T2, lactate metabolism was shifted towards a pattern opposite to the baseline: delta lactate extraction was −8% ± 16% in extractors at T1 versus 7% ± 9% in producers at T1 (
p = 0.003). Changes in WMSI were not correlated with changes in lactate utilization. No single preoperative variable predicted postoperative WMSI or its changes from baseline. Cardiopulmonary bypass (CPB) time was the only significant predictor of postoperative lactate extraction by multivariate regression (
r = −0.46,
p = 0.001): at T2, patients in the highest CPB time quartile showed frank lactate production (−6% ± 13%) when compared with those in the lowest quartile (15% ± 11%,
p = 0.005). However, postoperative WMSI was similar in different CPB time groups.
Conclusions:
Myocardial lactate metabolism pattern is not associated with functional status before and early after successful coronary revascularization. CPB time was the only significant predictor of postoperative lactate extraction. Measurement of lactate does not appear to be a valuable tool to assess the coupling of myocardial regional function and metabolism in the setting of coronary artery surgery and mild-to-moderate functional impairment.</abstract><cop>Philadelphia, PA</cop><pub>Elsevier Inc</pub><pmid>12968236</pmid><doi>10.1016/S1053-0770(03)00153-8</doi><tpages>8</tpages></addata></record> |
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| ispartof | Journal of cardiothoracic and vascular anesthesia, 2003-08, Vol.17 (4), p.478-485 |
| issn | 1053-0770 1532-8422 |
| language | eng |
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| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Aged Arteries - diagnostic imaging Arteries - metabolism Arteries - physiopathology Biological and medical sciences Biomarkers - analysis Blood Pressure - physiology Cardiopulmonary Bypass Coronary Artery Bypass coronary artery surgery Coronary Circulation - physiology Coronary Vessels - diagnostic imaging Coronary Vessels - metabolism Coronary Vessels - physiopathology Echocardiography Echocardiography, Transesophageal Female Heart Rate - physiology Humans lactate Lactic Acid - metabolism Male Medical sciences Middle Aged Multivariate Analysis Myocardial Contraction - physiology myocardial wall motion Myocardium - metabolism Myocardium - pathology Postoperative Period Predictive Value of Tests Prospective Studies Recovery of Function - physiology Statistics as Topic Stroke Volume - physiology Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the heart Time Factors transesophageal Treatment Outcome Vascular Resistance - physiology |
| title | Myocardial lactate metabolism in relation to preoperative regional wall motion and to early functional recovery after coronary revascularization |
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