Usefulness of 1H MR spectroscopy in the evaluation of myocardial metabolism in patients with dilated idiopathic cardiomyopathy: pilot study.
OBJECTIVE
Primary dilated cardiomyopathy is a disease of unknown etiology, and it leads to severe heart failure. Abnormalities of the cardiac metabolism can play an important role in prognosis and influence the symptomatology in this group. The aim of this study was to assess cardiac metabolism using proton spectroscopy magnetic resonance (1H MRS) and to examine whether there is any correlation between cardiac metabolites and functional New York Heart Association (NYHA) class and left ventricular function parameters obtained in echocardiography.


METHODS
Fifteen patients with documented idiopathic dilated cardiomyopathy and 12 healthy volunteers were examined. The study protocol included clinical examination, 12-lead electrocardiogram, two-dimensional echocardiogram, and 1H MRS with voxel localized at interventricular septum area. The contents of total creatine (CR) ie, creatine + phosphocreatine, lipids (LIP), lactates (LAC) and their ratios (CR1A, CR2A, CR1/H20, CR2/H20, CR2/CR1, LIPA, LIP/H20, LIP/CR1, LACA, LAC/H20, LAC/CR1) were examined.


RESULTS
Patients with dilated cardiomyopathy had significantly lower levels of creatine CRIA (5.04 +/- 0.88 vs 5.94 +/- 1.15, P < .02) and ratios LIP/H20 (4.34 +/- 2.3 vs 15.46 +/- 20.39, P < .04) and LIP/CR1 (24.49 +/- 21.26 vs 34.08 +/- 13.36, P < .05) compared with healthy volunteers. Significant correlations between NYHA functional class and the ratios CR2/CR1, CR2/H20 (r = 0.59, P < .038, r = 0.59, P < .02, respectively) and between %LVEF and LIP/CR1 (r = 0.64, P < .036), as well as between the duration of the disease (TCH) and LIP/CR1 (r = 0.67, P < .046) were found.


CONCLUSIONS
A pilot study with proton spectroscopy magnetic resonance showed impairment of the cardiac metabolism in patients with idiopathic dilated cardiomyopathy. A trend to lower values of creatine and lipids, and to lower ratios of some of these metabolites was observed in the dilated cardiomyopathy group compared with healthy subjects. The results require further study.
Walecki
Jerzy
J
Postgraduate Medical Center, Marymoncka St. 99, 01-813 Warsaw, Poland.
Michalak
Małgorzata J
MJ
Michalak
Ewa
E
Bilinska
Zofia T
ZT
Ruzyllo
Witold
W
D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology; D003401:Creatine / Q000032:analysis; D004452:Echocardiography; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000032:analysis; D008055:Lipids / Q000032:analysis; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D009206:Myocardium / Q000737:chemistry*; D010725:Phosphocreatine / Q000032:analysis; D016277:Ventricular Function, Left
D008055:Lipids; D010725:Phosphocreatine; D019344:Lactic Acid; D003401:Creatine