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CLINICAL RESEARCH

Proton magnetic resonance spectroscopy can detect creatine depletion associated with the progression of heart failure in cardiomyopathy

Ichiro Nakae, MD^*, Kenichi Mitsunami, MD^,*, Tomoko Omura, MD^*, Takahiro Yabe, MD^*, Takayoshi Tsutamoto, MD^*, Shinro Matsuo, MD^*, Masayuki Takahashi, MD^*, Shigehiro Morikawa, MD, Toshiro Inubushi, PhD, Yasuyuki Nakamura, MD^*, Masahiko Kinoshita, MD^* and Minoru Horie, MD^*

^* Department of Cardiovascular and Respiratory Medicine, Seta, Otsu, Japan
Department of General Medicine, Medical Coordination Center, Seta, Otsu, Japan
Molecular Neuroscience Research Center, Shiga University of Medical Science, Seta, Otsu, Japan

Manuscript received July 9, 2002; revised manuscript received November 19, 2002, accepted May 7, 2003.

^* Reprint requests and correspondence: Dr. Kenichi Mitsunami, Department of General Medicine, Medical Coordination Center, Shiga University of Medical Science, Seta, Otsu 520-2192, Japan.
mitunami{at}belle.shiga-med.ac.jp

OBJECTIVES: This study noninvasively examined total creatine (CR) of the myocardium in dilated cardiomyopathy (DCM) or hypertrophic cardiomyopathy (HCM) using proton magnetic resonance spectroscopy (¹H-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 ¹H-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 µmol/g wet weight [range 10.2 to 22.9], p < 0.05) than that in subjects with normal hearts (27.6 ± 4.1 µmol/g [range 21.4 to 36.2]). Myocardial CR in HCM patients (22.6 ± 8.1 µmol/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 ¹H-MRS can noninvasively detect CR depletion associated with the severity of HF in cardiomyopathy.

Abbreviations and Acronyms   BNP = B-type natriuretic peptide   CR = creatine   DCM = dilated cardiomyopathy   HCM = hypertrophic cardiomyopathy   HF = heart failure   1H- and 31P-MRS = proton and phosphorus-31 magnetic resonance spectroscopy, respectively   LV = left ventricular   LVEF = left ventricular ejection fraction   MRI = magnetic resonance imaging   MRS = magnetic resonance spectroscopy/spectroscopic   NML(1) = age-matched normal control group   NML(2) = non–age-matched larger normal control group   NYHA = New York Heart Association   PCr = phosphocreatine   PRESS = point-resolved spectroscopy   STEAM = stimulated-echo acquisition mode

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