title: 1H- and31P-myocardial magnetic resonance spectroscopy in non-obstructive hypertrophic cardiomyopathy patients and competitive athletes.
abstract: OBJECTIVE
  The clinical differentiation between athlete's heart and mild forms of non-obstructive hypertrophic cardiomyopathy (HCM) is crucial. We hypothesized that differences do exist between the myocardial metabolism of patients with non-obstructive HCM and competitive athletes (CAs). Our aim was to evaluate myocardial metabolism with31P-MRS and1H-MRS in HCM patients and CAs.
  
  
  METHODS
  After Ethics Committee approval, 15 CAs and 7 HCM patients were prospectively enrolled. They underwent a 1.5-T cardiac MR including electrocardiographically triggered cine images, single-voxel1H-MRS and multivoxel31P-MRS.1H-MRS was performed after imaging using standard coil with the patient in the supine position; thereafter,31P-MRS was performed using a dedicated coil, in the prone position. Data were reported as median and interquartile range. Mann-Whitney U test was used.
  
  
  RESULTS
  In CAs, left ventricular mass index was 72 (66-83) g/m2, septal thickness 10 (10-11) mm, end diastolic volume index 95 (85-102) ml/m2, end systolic volume index 30 (28-32) ml/m2and ejection fraction 68% (65-69%); in HCM patients, 81 (76-111) g/m2(P = 0.052), 18 (15-21) mm (P = 0.003), 73 (58-76) ml/m2(P = 0.029), 20 (16-34) ml/m2(P = 0.274) and 68% (55-73%) (P = 1.000), respectively. At1H-MRS, total lipids were 35 (0-183) arbitrary units (au) for CA and 763 (155-1994) au for HCM patients (P = 0.046). At31P-MRS, PCr/γATP was 5 (4-6) au for CA and 4 (2-5) au for HCM patients (P = 0.230). Examination time was 20 min for imaging only, 5 min for1H-MRS and 15 min for31P-MRS.
  
  
  CONCLUSIONS
  We observed a significant increase of myocardial lipids, but a preserved PCr/γATP ratio in the metabolism of HCM patients compared with competitive CAs.
authors.affiliation: Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Secchi
authors.affiliation: Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Di Leo
authors.affiliation: Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20100, Milan, Italy.
authors.forename: Marcello
authors.initials: M
authors.lastname: Petrini
authors.affiliation: Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono 7, 20100, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Spairani
authors.affiliation: Ph.D. Course in Integrated Biomedical Research, Università degli Studi di Milano, Via Mangiagalli 31, 20133, Milan, Italy. marco.ali90@gmail.com.
authors.forename: Marco
authors.identifier: http://orcid.org/0000-0001-8156-7743
authors.initials: M
authors.lastname: Alì
authors.affiliation: Cardiology University Department, IRCCS Policlinico San Donato, Università degli Studi di Milano, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Guazzi
authors.affiliation: Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, San Donato Milanese, 20097, Milan, Italy.|Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Morandi 30, 20133, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sardanelli
mesh_terms: D000328:Adult; D056352:Athletes; D055424:Cardiac-Gated Imaging Techniques; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000378:metabolism*; D005260:Female; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D010759:Phosphorus Isotopes; D011446:Prospective Studies
chemical_list: D010759:Phosphorus Isotopes
keywords: Athlete’s heart; Hypertrophic cardiomyopathy; Magnetic resonance spectroscopy; Myocardial metabolism