title: Proton magnetic resonance spectroscopy can detect creatine depletion associated with the progression of heart failure in cardiomyopathy.
abstract: OBJECTIVE
  This study noninvasively examined total creatine (CR) of the myocardium in dilated cardiomyopathy (DCM) or hypertrophic cardiomyopathy (HCM) using proton magnetic resonance spectroscopy ((1)H-MRS).
  
  
  BACKGROUND
  Abnormalities in CR metabolism in failing hearts have been reported. A biochemical study suggested that myocardial metabolic changes are very similar in DCM and HCM despite the different heart failure (HF) mechanisms.
  
  
  METHODS
  Using cardiac-gated (1)H-MRS with magnetic resonance image (MRI)-guided point-resolved spectroscopy (PRESS) localization, we quantitatively measured septal CR. Patients with either DCM (n = 11) or HCM (n = 7) and age-matched normal subjects (n = 14) were examined.
  
  
  RESULTS
  Myocardial CR was significantly lower in DCM patients (16.1 +/- 4.5 micromol/g wet weight [range 10.2 to 22.9], p < 0.05) than that in subjects with normal hearts (27.6 +/- 4.1 micromol/g [range 21.4 to 36.2]). Myocardial CR in HCM patients (22.6 +/- 8.1 micromol/g [range 12.2 to 34.5]) was significantly lower than that in subjects with normal hearts (p < 0.05) but was significantly higher than that in DCM patients (p < 0.05). In 18 patients with either DCM or HCM, myocardial CR correlated positively with left ventricular ejection fraction (LVEF) (y = 0.22x + 9.8, r = 0.73, p = 0.0006) but correlated negatively with plasma B-type natriuretic peptide (BNP) levels (y = -0.012x + 22.4, r = -0.54, p = 0.022).
  
  
  CONCLUSIONS
  This study showed that (1)H-MRS can noninvasively detect CR depletion associated with the severity of HF in cardiomyopathy.
authors: Department of Cardiovascular and Respiratory Medicine, Seta, Otsu, Japan.
authors: Ichiro
authors: I
authors: Nakae
authors: Kenichi
authors: K
authors: Mitsunami
authors: Tomoko
authors: T
authors: Omura
authors: Takahiro
authors: T
authors: Yabe
authors: Takayoshi
authors: T
authors: Tsutamoto
authors: Shinro
authors: S
authors: Matsuo
authors: Masayuki
authors: M
authors: Takahashi
authors: Shigehiro
authors: S
authors: Morikawa
authors: Toshiro
authors: T
authors: Inubushi
authors: Yasuyuki
authors: Y
authors: Nakamura
authors: Masahiko
authors: M
authors: Kinoshita
authors: Minoru
authors: M
authors: Horie
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000378:metabolism*; D003401:Creatine / Q000032:analysis*; D018450:Disease Progression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000378:metabolism; D009206:Myocardium / Q000737:chemistry*; D020097:Natriuretic Peptide, Brain / Q000032:analysis; D011522:Protons; D013318:Stroke Volume; D016277:Ventricular Function, Left
chemical_list: D011522:Protons; D020097:Natriuretic Peptide, Brain; D003401:Creatine