Myocardial substrate utilization and amino acid metabolism in chronic coronary artery disease.

Patients with typical effort angina have been considered to have normal myocardial metabolism at bodily rest (24). In contrast to this, the present study demonstrated, even in resting asymptomatic CAD patients, a decreased myocardial uptake of FFA, independent of arterial levels and probably reflecting a decreased capacity for FFA oxygenation. This was compensated for by increased aerobic, and in some cases anaerobic, carbohydrate utilization. Further more, there was increased alanine release and glutamate uptake, related to, and perhaps of importance for the maintenance of increased carbohydrate breakdown. The altered myocardial substrate preference related to the severity of ischemic disease, indicates a metabolic adaptation induced by chronic myocardial ischemia in CAD patients.