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154 OSBAKKEN ET AL<br />
Idtion (state 4 to state 3 : inactive to aetire state . although since hean is always working,<br />
it is always in some sense in slate 3) and protein synthesis, which are compensatory<br />
mechanisms associated with more ehornic volume loading conditions If the work<br />
Iqad increased (} HR X SBP). there would be greater activation of oxidative phos .<br />
phorylation ; if work load did not change signigcantly. there would be no need for<br />
flhnher activation of oxidative phosphorylotion . It may be possible m use measurement<br />
of these phenomena in the following way to estimate the noetabolic reserve and/or<br />
viability of the hean under clinical conditions where changes in myocardial loading<br />
occur. Small changes in P,/PCr and/ar PCr/ATP ratios may indicate that there is<br />
considerable metabolic reserve and thus myocardial function 6s stable . Larger changes<br />
in these ratios may indicate that myocardial metabolism is strverdy tased and there<br />
is minimal metabolic rcsen•e, thus making myocardial function relatively tess stable.<br />
Fa,nher studies using J' P NMR techniques will be needed to rnore speciflplly suppon<br />
tlv.ese hypotheses .<br />
ACKNOWLEDGMENTS<br />
The wthnD7lunkluhn HaH18rDte and laek L
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