Myocardial high-energy phosphate metabolism and allograft rejection in patients with heart transplants.
To determine whether myocardial high-energy phosphate metabolism is altered in cardiac allograft patients undergoing rejection, 14 patients with heart transplants were examined with image-guided, one-dimensional, phase-encoded surface-coil phosphorus-31 nuclear magnetic resonance (NMR) spectroscopy on 19 occasions 39-2,021 days after transplantation. On average, patients underwent mild rejection (detected with endomyocardial biopsy) and had a reduced ratio of anterior myocardial phosphocreatine (PCr) to adenosine triphosphate (ATP) (1.57 +/- 0.50 [standard deviation] vs 1.93 +/- 0.2; P less than .01) compared with that of 17 healthy control subjects. Ratios of PCr to inorganic phosphate also appeared lower whenever detectable. However, P-31 NMR spectroscopy did not permit reliable identification of patients who required augmented therapy for rejection detected with biopsy either on the day of the P-31 NMR spectroscopic study or at the next scheduled biopsy 10-140 days thereafter (sensitivity, 50%, and specificity, 73% with use of cardiac-averaged PCr/ATP values for each heart; sensitivity, 88%, and specificity, 55% with use of the lowest myocardial PCr/ATP ratios measured in each heart).
Bottomley
P A
PA
GE Research and Development Center, Schenectady, NY 12301.
Weiss
R G
RG
Hardy
C J
CJ
Baumgartner
W A
WA
D000255:Adenosine Triphosphate / Q000378:metabolism*; D001706:Biopsy; D004699:Endocardium / Q000473:pathology; D006084:Graft Rejection; D016027:Heart Transplantation / Q000473:pathology*; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism* / Q000473:pathology; D010725:Phosphocreatine / Q000378:metabolism*; D012680:Sensitivity and Specificity
D010725:Phosphocreatine; D000255:Adenosine Triphosphate