Myocardial oxygen extraction and oxygen-hemoglobin equilibrium curve during moderate exercise

Summary

Conditions of oxygen extraction by the myocardium have been studied in 12 subjects (44±9 years old) with pure mitral stenosis without clinical, metabolic or electrical sign of coronary insufficiency.

Oxygen-hemoglobin equilibrium curves (OHEC) have been determined on arterial, mixed venous and coronary sinus blood, at rest and during a moderate (60 W, 10 min) exercise performed on a bicycle ergometer in supine position. Physiological values, at rest and during exercise, of the following functional parameters of the OHEC were determined in the in-vivo conditions of pH and P_CO2∶P₅₀, n_Hill, DS max = maximal value of OHEC slope (DS=∂S_O2/∂P_O2), P_{DS max}, S_{DS max}. The concentration of plasma electrolytes capable to modify one of these parameters was controlled in each blood sample.

In coronary sinus blood, P₅₀ rises from 27.5±1.7 to 28.9±1.6 Torr during exercise (p<0.01). At rest, Hill's n in myocardial venous blood (2.67±0.09) is significantly higher than in arterial blood (2.61±0.08, p<0.01). A decrease in DS max (2.67±0.20 to 2.53±0.12%. Torr⁻¹; p<0.01) and an increase in P_{DS max} (20.9±1.9 to 22.6±2.1 Torr, p<0.01) are observed. At rest, the myocardial “venous point” (PcsO₂, ScsO₂) is not significantly distinct from the maximal slope point (P_{DS max}, S_{DS max}). After 1 min of exercise, a small gap appears which becomes significant at the end of the exercise (P_{DS max}-PcsO₂=0.2 Torr at rest, 2.7 Torr after exercise; S_{DS max}-ScsO₂=4.1% at rest, 7.9% after exercise). DS value at the myocardial venous point is only 2% at rest and 6% after exercise, lower than its maximal value.

The gap between venous point and DS max point could constitute an error signal in the regulation loop of the coronary circulation. The existence of a physiological receptor, sensitive to instant variations in myocardial tissue P_O2 and able to maintain venous point near DS max point could be considered.