Proton magnetic resonance spectroscopy can detect creatine depletion associated with the progression of heart failure in cardiomyopathy.
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.
Nakae
Ichiro
I
Department of Cardiovascular and Respiratory Medicine, Seta, Otsu, Japan.
Mitsunami
Kenichi
K
Omura
Tomoko
T
Yabe
Takahiro
T
Tsutamoto
Takayoshi
T
Matsuo
Shinro
S
Takahashi
Masayuki
M
Morikawa
Shigehiro
S
Inubushi
Toshiro
T
Nakamura
Yasuyuki
Y
Kinoshita
Masahiko
M
Horie
Minoru
M
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
D011522:Protons; D020097:Natriuretic Peptide, Brain; D003401:Creatine