Regional Metabolic Supply Dependency in Chronic Congestive Heart Failure

TLDR: The results demonstrate that the cerebral glucose utilization and therefore oxygen consumption increased parallel with Increases in DO2, contrary to the conventional concept that cerebral perfusion is strictly autoregulated and that substrate utilization is independent of oxygen delivery.

Abstract: We present a 64-year-old man with New York Heart Association (NYHA) Class III chronic congestive heart failure (CHF) who was examined for an alteration in cerebral cortex regional oxygen utilization as reflected by changes in local cerebral metabolic rates for glucose (LCMRglu). LCMRglu was determined by positron emission tomography at baseline and while oxygen delivery (DO2) was optimized during dobutamine infusion. Baseline DO2 was 8.31 mL/min/kg and cardiac output (CO) was 3.4 L/min, whereas oxygen consumption (VO2) measured by respired gas analysis was 3.64 mL/min/kg. At optimal dobutamine effect (7.5 μg/kg/min), DO2 increased to 16.8 mL/min/kg, CO to 7.2 L/min, and VO2MEAS was 3.67 mL/min/kg. Mean percentage Increase in cortical gray matter LCMRglu was 99.4 ± 11.7% (mean ± SD) and was statistically significant (p < 0.001; Student's paired t-test). Our results demonstrate that the cerebral glucose utilization and therefore oxygen consumption increased parallel with Increases in DO2. This phenomenon is contrary to the conventional concept that cerebral perfusion is strictly autoregulated and that substrate utilization is independent of oxygen delivery.