The study was designed to characterize the relationship between the me
tabolite content of human cardiac muscle and in vivo cardiac function.
ATP, total adenine nucleotides, and NAD were quantified in human myoc
ardial biopsies using high performance liquid chromatography. Right ve
ntricular endomyocardial biopsies were obtained from 43 patients with
dilated cardiomyopathy, 6 with restrictive cardiomyopathy, 10 with nor
mal systolic and diastolic function, and from 24 cold preserved human
donor hearts. Transmural samples of failing right and left ventricular
free walls were obtained during cardiac transplantation surgery in 8
patients. ATP, total adenine nucleotides, and NAD were similar in the
cold-preserved donor hearts and in right ventricular endomyocardial bi
opsies from the 10 individuals with normal systolic and diastolic func
tion. In contrast, these values were significantly depressed in tissue
samples from patients with dilated or restrictive cardiomyopathy. The
re was a significant correlation between ATP and pulmonary capillary w
edge pressures but not ejection fractions. Declines in the sizes of my
ocardial ATP, adenine nucleotide, and pyridine nucleotide pools in the
human myocardium are associated primarily with diastolic but not syst
olic dysfunction.