The Annals of Thoracic Surgery, Vol 32, 546-553, Copyright © 1981 by The Society of Thoracic Surgeons
Transmural gradient in high-energy phosphate content in patients with coronary artery disease
RN Jones, RB Peyton, RL Sabina, JL Swain, EW Holmes, TL Spray, P Van Trigt and AS Wechsler
In 16 patients undergoing elective coronary artery bypass, transmural
biopsies were performed during bypass but before global ischemia.
Subendocardial and subepicardial halves were separately assayed in each
sampled tissue. Adenosine triphosphate (ATP) levels, total adenine
nucleotide content (sigma Ad), and creatine phosphate (CP) content were
significantly higher (p less than 0.005) in the subepicardium than the
subendocardium in regions of the heart distal to major occlusions: 35.36
+/- 2.12 nmole/mg versus 28.7 +/- 1.7 (ATP), 42.24 +/- 2.04 versus 35.6 +/-
1.6 (sigma Ad), and 29.99 +/- 4.32 +/- versus 16.35 +/- 3.48 (CP). The
opposite was true in two hearts with normal coronary arteries, in which
high-energy phosphates tended to be higher in the subendocardium than the
subepicardium. A transmural metabolic gradient therefore exists in regions
of the myocardium distal to significant coronary occlusive disease. The
subendocardium's relative depression in metabolic reserve cold determine
its susceptibility to ischemic damage and influence techniques designed to
preserve the heart during ischemia.