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CLINICAL STUDIES

Cerebral metabolic abnormalities in congestive heart failure detected by proton magnetic resonance spectroscopy

Cheol Whan Lee, MD^*, Jung-Hee Lee, PhD, Jae-Joong Kim, MD^*, Seong-Wook Park, MD, PhD, FACC^*, Myeong-Ki Hong, MD^*, Sang-Tae Kim, BS, Tae-Hwan Lim, MD, PhD and Seung-Jung Park, MD, PhD, FACC^*

^* Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, South Korea
Asan Institute for Life Science, Asan Medical Center, University of Ulsan, Seoul, South Korea
Department of Radiology, Asan Medical Center, University of Ulsan, Seoul, South Korea

Manuscript received August 10, 1998; revised manuscript received November 6, 1998, accepted December 23, 1998.

Reprint requests and correspondence: Dr. Seung-Jung Park, Department of Medicine, University of Ulsan, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea
sjpark{at}www.amc.seoul.kr

OBJECTIVES

Using proton magnetic resonance spectroscopy, we investigated cerebral metabolism and its determinants in congestive heart failure (CHF), and the effects of cardiac transplantation on these measurements.

BACKGROUND

Few data are available about cerebral metabolism in CHF.

METHODS

Fifty patients with CHF (ejection fraction 35%) and 20 healthy volunteers were included for this study. Of the patients, 10 patients underwent heart transplantation. All subjects performed symptom-limited bicycle exercise test. Proton magnetic resonance spectroscopy (¹H MRS) was obtained from localized regions (8 to 10 ml) of occipital gray matter (OGM) and parietal white matter (PWM). Absolute levels of the metabolites (N-acetylaspartate, creatine, choline, myo-inositol) were calculated.

RESULTS

In PWM only creatine level was significantly lower in CHF than in control subjects, but in OGM all four metabolite levels were decreased in CHF. The creatine level was independently correlated with half-recovery time and duration of heart failure symptoms in PWM (r = –0.56, p < 0.05), and with peak oxygen consumption and serum sodium concentration in OGM (r = 0.58, p < 0.05). Cerebral metabolic abnormalities were improved after successful cardiac transplantation.

CONCLUSIONS

This study shows that cerebral metabolism is abnormally deranged in advanced CHF and it may serve as a potential marker of the disease severity.

Abbreviations and Acronyms   CHF = congestive heart failure   Cho = choline   Cr = creatine   1H MRS = proton magnetic resonance spectroscopy   mI = myo-inositol   NAA = N-acetylaspartate   NYHA = New York Heart Association   OGM = occipital gray matter   PWM = parietal white matter

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