Acute alterations in blood lactate in the setting of transient stress induced myocardial ischaemia

Q: What was the primary aim of the investigation?

To assess how dobutamine stress changes venous blood lactate levels in the presence and absence of myocardial ischaemia, and how these changes relate to adverse outcomes at 1 year.

Q: How were patients classified during dobutamine stress echocardiography?

Patients were categorized as ischaemic (IS) or non-ischaemic (NI) responders based on their response during dobutamine stress echocardiography.

Q: Which measures independently predicted an adverse 1-year cardiac event?

Global longitudinal strain and venous lactate at 10 minutes into recovery were significant independent predictors of an adverse event.

Sep 28, 2026

Uploaded by Genevieve

An elevation in resting venous blood lactate levels associated with myocardial hypoperfusion predicts adverse prognosis. This study evaluated dobutamine-stress induced changes in venous lactate in ischaemic versus non-ischaemic responders and examined 1-year adverse outcomes. Four hundred and four patients with chest pain underwent dobutamine stress echocardiography, with lactate sampling at rest, peak stress, and multiple recovery timepoints using a Lactate Pro 2 device. Lactate and GLS differed between groups and independently predicted events.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages13

Reading Time33 min

AccessFree to download

Abstract

Introduction

Cardiac metabolism and lactate production in myocardial ischaemia

Limits of current metabolic and electrocardiographic markers

Role of dobutamine stress echocardiography in assessing myocardial mechanics

DOI: 10.1113/EP092429 RESEARCH ARTICLE Acute alterations in blood lactate in the setting of transient stress induced myocardial ischaemia Jamie M. O’Driscoll1, 2 Elliot Smith1 Matchel Bibat1 Jamie J. Edwards1, 3 Claire Compton1 Konstantina Kipourou1 Damian Coleman4 Jonathan Wiles4 Eliane Cunliffe1 Anna Marciniak1 Rajan Sharma1 1 Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, Tooting, London, UK 2 Diabetes Research Centre, College of Life Sciences, University of Leicester, Leicester, UK 3 Department of Applied Sport and Exercise Science, University of East London, London, UK 4School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, UK Correspondence Jamie O’Driscoll and Rajan Sharma, Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK. [Email:](Email: jod16@leicester.ac.uk and)[ jod16@leicester.ac.uk](Email: jod16@leicester.ac.uk and)[ and](Email: jod16@leicester.ac.uk and)[ ](Email: jod16@leicester.ac.uk and)[rajan.sharma@stgeorges.nhs.uk](rajan.sharma@stgeorges.nhs.uk) Handling Editor: Peter Rasmussen Abstract An elevation in resting venous blood lactate ([La− ]b ) levels in conditions of myocardial hypoperfusion is associated with adverse prognosis and survival. This investigation aimed to assess changes in venous [La− ]b levels induced by dobutamine stress in the presence and absence of myocardial ischaemia and adverse outcomes at 1 year. Four hundred and four consecutive patients (mean age 70 ± 10 years, 243 male) reporting chest pain underwent dobutamine stress echocardiography (DSE) and were categorised as ischaemic (IS) or non-ischaemic (NI) responders. Conventional and global longitudinal strain (GLS) echocardiographic measures were recorded at rest. Venous [La− ]b samples were acquired at rest, peak stress and 1, 3, 5 and 10 min into recovery using a commercially available Lactate Pro 2 device. There were no significant differences in [La− ]b concentrations between IS (1.75 ± 0. 76 mmol L−1) and NI (1.73 ± 0. 60 mmol L−1) responders at baseline (P = 0. 592). However,[La− ]b concentrations were significantly greater at peak stress (1.83 ± 0.57 vs. 1.68 ± 0. 60 mmol L−1), 1 (1.90 ± 0. 56 vs. 1.73 ± 0. 71 mmol L−1), 3 (1.97 ± 0.56 vs. 1.73 ± 0. 71 mmol L−1), 5 (1.98 ± 0. 60 vs. 1.74 ± 0. 70 mmol L−1) and 10 min (2.01 ± 0. 63 vs. 1.76 ± 0. 71 mmol L−1) into recovery between IS and NI responders (all P < 0.001). GLS was significantly lower in IS compared to NI (−15.5 ± 2. 9 vs.−16.2% ± 2. 7%, P = 0.02) responders at baseline. In patients who experienced an adverse cardiac event during 1 year of follow-up, GLS (−14.4 ± 2. 7 vs. −16. 1% ± 2.8%, P < 0.001) and [La− ]b concentrations were significantly lower at baseline (1.54 ± 0.55 vs. 1.78 ± 0. 70 mmol L−1 , P = 0.02), as were [La− ]b concentrations at 5 (1.68 ± 0.55 vs. 1.88 ± 0. 68 mmol L−1 , P = 0.04) and 10 min (1.70 ± 0. 56 vs. 1.93 ± 0. 71 mmol L−1 , P = 0.02) into recovery compared to patients who did not experience an adverse event. GLS (hazard ration (HR) 1.21; 95% CI: 1.11–1.33, P < 0.001) and [La− ]b concentrations at 10 min into recovery (HR 0.54; 95% CI: 0.33–0.85, P = 0.01) were significant independent predictors of an adverse event. Transient myocardial ischaemia is associated with a significant elevation in [La− ]b concentrations, which This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society. O’DRISCOLL ET AL. 99 extends into the recovery period, compared to NI responders. A blunted metabolic response to dobutamine stress and attenuated longitudinal myocardial mechanics are independently associated with short-term

FAQs

What was the primary aim of the investigation?

To assess how dobutamine stress changes venous blood lactate levels in the presence and absence of myocardial ischaemia, and how these changes relate to adverse outcomes at 1 year.

How were patients classified during dobutamine stress echocardiography?

Patients were categorized as ischaemic (IS) or non-ischaemic (NI) responders based on their response during dobutamine stress echocardiography.

Which measures independently predicted an adverse 1-year cardiac event?

Global longitudinal strain and venous lactate at 10 minutes into recovery were significant independent predictors of an adverse event.

Sep 28, 2026

Uploaded by Genevieve