Advertisement

European Radiology

, Volume 15, Issue 2, pp 319–323 | Cite as

Noninvasive measurements of cardiac high-energy phosphate metabolites in dilated cardiomyopathy by using 31P spectroscopic chemical shift imaging

  • A. Hansch
  • R. Rzanny
  • J.-P. Heyne
  • U. Leder
  • J. R. Reichenbach
  • W. A. Kaiser
Cardiac

Abstract

Dilated cardiomyopathy (DCM) is accompanied by an impaired cardiac energy metabolism. The aim of this study was to investigate metabolic ratios in patients with DCM compared to controls by using spectroscopic two-dimensional chemical shift imaging (2D-CSI). Twenty volunteers and 15 patients with severe symptoms (left ventricular ejection fraction, LVEF<30%) and ten patients with moderate symptoms (LVEF>30%) of DCM were investigated. Cardiac 31P MR 2D-CSI measurements (voxel size: 40×40×100 mm3) were performed with a 1.5 T whole-body scanner. Measurement time ranged from 15 min to 30 min. Peak areas and ratios of different metabolites were evaluated, including high-energy phosphates (PCr, ATP), 2,3-diphosphoglycerate (2,3-DPG) and phosphodiesters (PDE). In addition, we evaluated how PCr/ATP ratios correlate with LVEF as an established prognostic factor of heart failure. The PCr/γ-ATP ratio was significantly decreased in patients with moderate and severe DCM and showed a linear correlation with reduced LVEFs. PDE/ATP ratios were significantly increased only in patients with severe DCM as compared to volunteers. Applying 31P MRS with commonly-available 2D-CSI sequences is a valuable technique to evaluate DCM by determining PCr/ATP ratios noninvasively. In addition to reduced PCr/ATP ratios observed in patients suffering from DCM, significantly-increased PDE/ATP ratios were found in patients with severe DCM.

Keywords

Spectroscopy Dilated cardiomyopathy Chemical shift imaging High-energy phosphates 

Notes

Acknowledgement

The authors thank Ines Krumbein and Urte Jäger for excellent technical assistance.

References

  1. 1.
    Fatkin D, Graham RM (2002) Molecular mechanisms of inherited cardiomyopathies. Physiol Rev 82:945–980Google Scholar
  2. 2.
    Bottomley PA (1994) MR spectroscopy of the human heart: the status and the challenges. Radiology 191:593–612Google Scholar
  3. 3.
    Ingwall JS (1982) Phosphorus nuclear magnetic resonance spectroscopy of cardiac and skeletal muscles. Am J Physiol 242:729–744Google Scholar
  4. 4.
    Schaefer S, Gober J, Valenza M, Karczmar GS, Matson GB, Camacho SA, Botvinick EH, Massie B, Weiner MW (1988) Nuclear magnetic resonance imaging-guided phosphorus-31 spectroscopy of the human heart. J Am Coll Cardiol 12:1449–1455Google Scholar
  5. 5.
    Schaefer S, Massie B, Weiner MW (1989) Magnetic resonance spectroscopy of the heart. Cardiol Clin 7:697–712Google Scholar
  6. 6.
    Sandstede JJ (2003) Assessment of myocardial viability by MR imaging. Eur Radiol 13:52–61PubMedGoogle Scholar
  7. 7.
    Schaefer S, Gober JR, Schwartz GG, Twieg DB, Weiner MW, Massie B (1990) In vivo phosphorus-31 spectroscopic imaging in patients with global myocardial disease. Am J Cardiol 65:1154–1161CrossRefGoogle Scholar
  8. 8.
    Auffermann W, Chew WM, Wolfe CL, Tavares NJ, Parmley WW, Semelka RC, Donnelly T, Chatterjee K, Higgins CB (1991) Normal and diffusely abnormal myocardium in humans: functional and metabolic characterization with P-31 MR spectroscopy and cine MR imaging. Radiology 179:253–259Google Scholar
  9. 9.
    Masuda Y, Tateno Y, Ikehira H, Hashimoto T, Shishido F, Sekiya M, Imazeki Y, Imai H, Watanabe S, Inagaki Y (1992) High-energy phosphate metabolism of the myocardium in normal subjects and patients with various cardiomyopathies—the study using ECG gated MR spectroscopy with a localization technique. Jpn Circ J 56:620–626Google Scholar
  10. 10.
    Hardy CJ, Weiss RG, Bottomley PA, Gerstenblith G (1991) Altered myocardial high-energy phosphate metabolites in patients with dilated cardiomyopathy. Am Heart J 122:795–801CrossRefGoogle Scholar
  11. 11.
    Neubauer S, Krahe T, Schindler R, Horn M, Hillenbrand H, Entzeroth C, Mader H, Kromer EP, Riegger GA, Lackner K et al (1992) 31P magnetic resonance spectroscopy in dilated cardiomyopathy and coronary artery disease. Altered cardiac high-energy phosphate metabolism in heart failure. Circulation 86:1810–1818Google Scholar
  12. 12.
    Bottomley PA, Hardy CJ (1992) Proton overhauser enhancements in human cardiac phosphorus NMR spectroscopy at 1.5 T. Magn Reson Med 24:384–390Google Scholar
  13. 13.
    Loffler R, Sauter R, Kolem H, Haase A, von Kienlin M (1998) Localized spectroscopy from anatomically matched compartments: improved sensitivity and localization for cardiac 31P MRS in humans. J Magn Reson 134:287–299CrossRefGoogle Scholar
  14. 14.
    Meininger M, Landschuetz W, Beer M, Seyfarth T, Horn M, Pabst T, Haase A, Hahn D, Neubauer S, von Kienlin M (1999) Concentrations of human cardiac phosphorus metabolites determined by SLOOP 31P NMR spectroscopy. Magn Reson Med 41:657–663Google Scholar
  15. 15.
    Rector TS, Cohn JN (1994) Prognosis in congestive heart failure. Annu Rev Med 45:341–350CrossRefGoogle Scholar
  16. 16.
    Schaefer S (1990) Clinical nuclear magnetic resonance spectroscopy: insight into metabolism. Am J Cardiol 66:45–50CrossRefGoogle Scholar
  17. 17.
    Krahe T, Schindler R, Neubauer S, Ertl G, Horn M, Lackner K (1993) 31P-cardio-MR-spectroscopy in myocardial insufficiency. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 159:64–70Google Scholar
  18. 18.
    Schindler R, Krahe T, Neubauer S, Hillenbrand H, Entzeroth C, Horn M, Lackner K, Ertl G (1992) The direct measurement of the spin-grid-relaxation times of phosphorus metabolites in the human myocardium. Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 157:452–457Google Scholar
  19. 19.
    Ye Y, Gong G, Ochiai K, Liu J, Zhang J (2001) High-energy phosphate metabolism and creatine kinase in failing hearts: a new porcine model. Circulation 103:1570–1576Google Scholar
  20. 20.
    Green DR, Reed JC (1998) Mitochondria and apoptosis. Science 281:1309–1312CrossRefPubMedGoogle Scholar
  21. 21.
    Neubauer S, Horn M, Cramer M, Harre K, Newell JB, Peters W, Pabst T, Ertl G, Hahn D, Ingwall JS, Kochsiek K (1997) Myocardial phosphocreatine-to-ATP ratio is a predictor of mortality in patients with dilated cardiomyopathy. Circulation 96:2190–2196Google Scholar
  22. 22.
    van Dobbenburgh JO, Lekkerkerk C, van Echteld CJ, de Beer R (1994) Saturation correction in human cardiac 31P MR spectroscopy at 1.5 T. NMR Biomed 7:218–224Google Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • A. Hansch
    • 1
  • R. Rzanny
    • 1
  • J.-P. Heyne
    • 1
  • U. Leder
    • 2
  • J. R. Reichenbach
    • 1
  • W. A. Kaiser
    • 1
  1. 1.Institute of Diagnostic and Interventional RadiologyFriedrich Schiller University JenaJenaGermany
  2. 2.Department of Internal MedicineFriedrich Schiller University JenaJenaGermany

Personalised recommendations