Assessment of myocardial free fatty acid metabolism in humans during heparin infusion.

: Free fatty acids (FFA) have been shown to be a major myocardial substrates during the postabsorptive state in humans. In order to document the utilization of these substrates by the heart while heparin was infused, the following study was designed. During heparin infusion, total and individual FFA were measured in arterial and coronary sinus plasma during the postabsorptive state in 13 patients with coronary artery disease and in 4 patients with no evidence of cardiac disease. Oleic-1-14C acid bound to albumin was infused at a constant rate for at least 7 min into the left coronary artery. Left coronary blood flow was determined in all patients. It was assumed the oleic-1-14C acid behaves like endogenous FFA. Arterial FFA concentration was high (mean and SEM: 1 +/- 0.21 mumoles/ml) and varied by less than 10% during the course of the study in 14 of the 17 patients. Oleic acid constituted 44% of all arterial FFA. The relative concentrations of the various individual FFA were similar in arterial and coronary sinus plasma. The average FFA extraction was 19.9 +/- 2.1%. In contrast, the oleic-1-14C acid extraction was relatively more steady during the infusion, and the mean extraction of this tracer was 36.0 +/- 2.1%. Myocardial uptake for the entire group was 52.3 +/- 6.3 mumoles/min. Although a definite plateau for 14CO2 release from oleic-1-14C acid oxidation was not obtained, at least 31.8 +/- 4.3% of the removed FFA was oxidized, representing 49.3 +/- 6.4% of myocardial oxygen consumption. The failure of oleic-1-14C acid oxidation to reach a steady state was not due to delay in the myocardial CO2 pool, since 14CO2 release from infused NaH 14CO3 and lactate-1-14C in 11 other subjects revealed that in equilibrium was obtained within 5 min. These findings indicate that the generation of 14CO2 from oleic-1-14C acid oxidation is relatively slow, and the uptake of labeled FFA is partly matched by release of unlabeled FFA, suggesting that the human heart has important lipid pools.