Circulation, Vol 86, 1810-1818, Copyright © 1992 by American Heart Association
S Neubauer, T Krahe, R Schindler, M Horn, H Hillenbrand, C Entzeroth, H Mader, EP Kromer, GA Riegger and K Lackner
BACKGROUND. The purpose of this work was to further define the value of
cardiac 31P magnetic resonance (MR) spectroscopy for patients with coronary
artery disease and dilated cardiomyopathy. METHODS AND RESULTS.
Blood-corrected and T1-corrected 31P MR spectra of anteroseptal myocardium
were obtained at rest using image-selected in vivo spectroscopy
localization, a selected volume of 85 +/- 12 cm3, and a field strength of
1.5 T. Nineteen volunteers had a creatine phosphate (CP)/ATP ratio of 1.95
+/- 0.45 (mean +/- SD) and a PDE/ATP ratio of 1.06 +/- 0.53; in four
patients with left anterior descending coronary artery (LAD) stenosis, six
patients with chronic anterior wall infarction, and four patients with
chronic posterior wall infarction, CP/ATP and phosphodiester (PDE)/ATP
ratios did not differ from those in volunteers. Twenty-five measurements of
19 patients with dilated cardiomyopathy yielded a CP/ATP of 1.78 +/- 0.51
and a PDE/ATP of 0.98 +/- 0.56 (p = NS versus volunteers). When these
patients were grouped according to the severity of heart failure, however,
CP/ATP was 1.94 +/- 0.43 in mild (p = NS versus volunteers) and 1.44 +/-
0.52 in severe DCM (p < 0.05), respectively. No correlation was found
between CP/ATP and left ventricular ejection fraction or fractional
shortening, but correlation of CP/ATP with the New York Heart Association
(NYHA) class was significant (r = 0.60, p < 0.005). Six patients with
dilated cardiomyopathy were studied repeatedly before and after 12 +/- 6
weeks of drug treatment leading to clinical recompensation with improvement
of the NYHA status by 0.8 +/- 0.3 classes. Concomitantly, CP/ATP increased
from 1.51 +/- 0.32 to 2.15 +/- 0.27 (p < 0.01), whereas PDE/ATP did not
change significantly. CONCLUSIONS. Cardiac high-energy phosphate metabolism
at rest is normal in LAD stenosis and chronic myocardial infarction in the
absence of heart failure. The CP/ATP ratio has low specificity for the
diagnosis of dilated cardiomyopathy. However, CP/ATP correlated with the
clinical severity of heart failure and may improve during clinical
recompensation.
ARTICLES
31P magnetic resonance spectroscopy in dilated cardiomyopathy and coronary artery disease. Altered cardiac high-energy phosphate metabolism in heart failure
Department of Medicine, Wurzburg University, FRG.
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