title: Cardiac metabolism and function in patients with multiple sclerosis: a combined 31P-MR-spectroscopy and MRI study.
abstract: OBJECTIVE
  Involvement of the autonomic system in multiple sclerosis (MS) may concur with dysfunction of the cardiovascular system. The introduction of potentially cardiotoxic immunosuppressive drugs like Mitoxantrone into the treatment of MS warrants proper assessment of preexisting heart disease. However, systematic analyses of functional and metabolic derangements in MS are missing. Using quantitative 31P-MR-spectroscopy (MRS) and MR-imaging (MRI) metabolic and functional parameters were analyzed in patients with MS in comparison to healthy volunteers.
  
  
  METHODS
  14/15 patients with MS could be included in the study, as the MRS examination of one patient had to be excluded from analysis due to movement during the examination. Using chemical shift imaging (CSI) and AMARES, phosphocreatine (PCr) to adenosine triphosphate (ATP) ratios, characterizing myocardial high-energy phosphate metabolism, were determined. Additionally, absolute concentrations of PCr and ATP were calculated by SLOOP (Spatial Localization with Optimal Pointspread Function). Analysis of functional changes was performed by Cine-MRI. 14 healthy volunteers matched for age and gender served as control.
  
  
  RESULTS
  A significant decrease of absolute PCr concentration was observed in patients with MS compared to matched volunteers (p < 0.05), whereas ATP concentrations showed no significant changes (p = 0.27). Metabolite ratios calculated by SLOOP or AMARES showed a tendency to be reduced in patients, however, did not reach significance (p = 0.08, SLOOP; p = 0.47, AMARES). Using volunteers' mean values +/- 2 x SD as cut off value revealed PCr changes in 5 of 14 patients, whereas only 2 also had pathologic PCr/ATP ratios. Functional analysis by MRI depicted depressed left ventricular ejection fraction in 4 patients.
  
  
  CONCLUSIONS
  The reduction in cardiac high-energy phosphates in some patients with MS points to a subclinical involvement of the heart. This may be important for treatment with potentially cardiotoxic drugs. Longitudinal studies are need to understand the clinical relevance of our findings.
authors: Institut für Röntgendiagnostik, Universität Würzburg, Germany. meinrad.beer@mail.uni-wuerzburg.de
authors: M
authors: M
authors: Beer
authors: J
authors: J
authors: Sandstede
authors: F
authors: F
authors: Weilbach
authors: M
authors: M
authors: Spindler
authors: S
authors: S
authors: Buchner
authors: A
authors: A
authors: Krug
authors: H
authors: H
authors: Köstler
authors: T
authors: T
authors: Pabst
authors: W
authors: W
authors: Kenn
authors: W
authors: W
authors: Landschütz
authors: M
authors: M
authors: von Kienlin
authors: K V
authors: KV
authors: Toyka
authors: G
authors: G
authors: Ertl
authors: R
authors: R
authors: Gold
authors: D
authors: D
authors: Hahn
mesh_terms: D000255:Adenosine Triphosphate / Q000378:metabolism*; D000328:Adult; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis / Q000503:physiopathology*; D009206:Myocardium / Q000378:metabolism*; D010725:Phosphocreatine / Q000378:metabolism*; D013318:Stroke Volume / Q000502:physiology*
chemical_list: D010725:Phosphocreatine; D000255:Adenosine Triphosphate