What is the clinical evidence from this study?

Study design: RCT. Population: acute right ventricular pressure overload (n=22). Intervention: pulmonary artery banding vs. sham operation. Primary outcome: Fractional contributions of medium-chain fatty acids to citric acid cycle.

What question did this study set out to answer?

To determine whether the immature right ventricle fails to adapt substrate metabolism to meet the heightened energetic demands induced by acute pressure overload.

May 30, 2018Journal of the American Heart AssociationOpen Access

Metabolic Response of the Immature Right Ventricle to Acute Pressure Overloading

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Key result

Pulmonary artery banding in infant piglets significantly decreased the fractional contribution of medium-chain fatty acids to the citric acid cycle compared to sham operation (8.2% vs 14.5%).

Why the study?

Does pulmonary artery banding alter substrate metabolism in the immature right ventricle of infant piglets?

Key Points

To determine whether the immature right ventricle fails to adapt substrate metabolism to meet the heightened energetic demands induced by acute pressure overload.
Randomized 22 infant male mixed-breed Yorkshire piglets to either a sham control operation or pulmonary artery banding producing a >2-fold elevation in right ventricular systolic pressure.
Assessed right ventricular substrate metabolism and energetic flux using carbon 13-labeled substrates alongside proton nuclear magnetic resonance spectroscopy.
Pulmonary artery banding significantly reduced the phosphocreatine-to-ATP ratio, which demonstrated an inverse correlation with energy demand indexed by maximal right ventricular-to-left ventricular systolic pressure.
Fractional contributions of fatty acids to the citric acid cycle were significantly lower after banding compared to controls (medium-chain: 8.2±1.0% vs 14.5±1.6%; long-chain: 5.1±1.1% vs 9.3±1.5%).
Carbon-13 flux analysis revealed that pyruvate decarboxylation flux failed to increase to compensate for reduced fatty acid oxidation during acute pressure overload.

Study Design

Type

RCT (n=22)

Randomization

randomized

Structured PICO

Does pulmonary artery banding alter substrate metabolism in the immature right ventricle of infant piglets?

Population

22 infant male mixed breed Yorkshire piglets randomized to sham operation or pulmonary artery banding to induce acute right ventricular pressure overload.

Intervention

Pulmonary artery banding yielding >2-fold elevation over baseline RV systolic pressure

Comparator

Sham operation (Control)

Outcome

RV energy metabolism assessed by [Phosphocreatine]/[ATP] ratio and fractional contributions of fatty acids to citric acid cycle using 13C-labeled substrates and proton nuclear magnetic resonancesurrogate

Main Result

Absolute Event Rate: 8.2% vs 14.5%

Acute RV pressure overload in the immature right ventricle causes energy imbalance due to decreased relative fatty acid oxidation without a reciprocal increase in pyruvate decarboxylation.

Discussion

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Implication

Acute RV pressure overload may cause energy imbalance in immature RV; leaves open translation to human congenital heart disease.

Cite This Study

Kajimoto et al. (2018) conducted an RCT in acute right ventricular pressure overload (n=22). pulmonary artery banding vs. sham operation was evaluated on Fractional contributions of medium-chain fatty acids to citric acid cycle. Pulmonary artery banding in infant piglets significantly decreased the fractional contribution of medium-chain fatty acids to the citric acid cycle compared to sham operation (8.2% vs 14.5%).

synapsesocial.com/papers/6a845d47ac510c864ff30dd7 https://doi.org/10.1161/jaha.118.008570

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Metabolic Response of the Immature Right Ventricle to Acute Pressure Overloading

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

Metabolic Response of the Immature Right Ventricle to Acute Pressure Overloading

Key Points

Study Design

Structured PICO

Main Result

Discussion

Implication

Cite This Study

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