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CLINICAL RESEARCH: HEART FAILURE

Effects of Exercise Training on Myocardial Energy Metabolism and Ventricular Function Assessed by Quantitative Phosphorus-31 Magnetic Resonance Spectroscopy and Magnetic Resonance Imaging in Dilated Cardiomyopathy

Meinrad Beer, MD^_*,_*, Doris Wagner, MD, Jonathan Myers, PhD, Jörn Sandstede, MD^_*, Herbert Köstler, PhD^_*, Dietbert Hahn, MD^_*, Stefan Neubauer, MD, FRCP and Paul Dubach, MD

^_* Institut für Röntgendiagnostik, Universität Würzburg, Würzburg, Germany
Medizinische Klinik Kantonsspital Chur, Chur, Switzerland
Palo Alto Veterans Affairs Medical Center and Stanford University, Palo Alto, California
Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom.

Manuscript received April 23, 2007; revised manuscript received August 27, 2007, accepted September 23, 2007.

^_* Reprint requests and correspondence: Dr. Meinrad Beer, Institut für Röntgendiagnostik, Universität Würzburg, Josef-Schneider-Strasse 2, D-97080 Würzburg, Germany. (Email: beer{at}roentgen.uni-wuerzburg.de).

Objectives: The present study investigated changes in cardiac energy metabolism and function in patients with dilated cardiomyopathy (DCM) before and after exercise training (ET) with phosphorus-31 magnetic resonance spectroscopy (MRS) in combination with magnetic resonance imaging (MRI).

Background: Exercise training might have a beneficial role on myocardial function and oxidative metabolism in DCM, but it is unclear whether the additional load on the failing heart leads to deterioration of cardiac energy metabolism.

Methods: Twenty-four patients were randomized to an exercise (age 53 ± 12 years) or a control (age 56 ± 6 years) group. Supervised ET was performed for 2 months, followed by 6 months of self-regulated training. At baseline and 2 and 8 months, maximal exercise testing along with quantitative MRS and MRI studies were performed.

Results: The effectiveness of ET was demonstrated by a 17% increase in peak oxygen uptake (p < 0.05). Exercise training improved left ventricular (LV) end-systolic volume (p < 0.05) and LV ejection fraction (30 ± 15% vs. 37 ± 15%; p < 0.01) but not right ventricular parameters. The improvement in cardiac function was not accompanied by changes in cardiac high-energy phosphate concentrations; phosphocreatine, adenosine triphosphate, and the phosphocreatine/adenosine triphosphate ratio were all unchanged after training.

Conclusions: The observation that LV function improved and LV energy metabolism remained unchanged suggests that the beneficial effect of ET on LV function is achieved without adversely affecting metabolism. These findings lend further support for the use of ET as an adjunct therapy in DCM.

Abbreviations and Acronyms   ATP = adenosine triphosphate   DCM = dilated cardiomyopathy   EF = ejection fraction   ET = exercise training   LV = left ventricular   MRI = magnetic resonance imaging   MRS = magnetic resonance spectroscopy   PCr = phosphocreatine   PET = positron emission tomography   RV = right ventricular   SLOOP = Spatial Localization with Optimum Pointspread Function   VO 2 = oxygen uptake   31P = phosphorus-31

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