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
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Figure 1 Spin-echo magnetic resonance imaging (A) and point-resolved spectroscopy spectrum (B) in a 2 x 2 x 2-cm voxel in an intraventricular septum (white box) of a 66-year-old healthy woman as a normal (NML) volunteer. Total creatine resonance at 3.0 ppm (arrow). The creatine concentration is 25.0 µmol/g wet weight. Lipid resonance at 0.9 to 1.4 ppm.
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Figure 2 Correlation between the age and the myocardial concentration of total creatine (CR) in the 22 normal subjects.
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Figure 3 Representative spin-echo magnetic resonance imaging (A) and cardiac proton magnetic resonance spectrum (B) from a patient with dilated cardiomyopathy (DCM) (a 45-year-old man). A low creatine peak (3.0 ) (arrow) is observed in DCM (10.2 µmol/g wet weight).
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Figure 4 Representative spin-echo magnetic resonance imaging (A) and cardiac proton magnetic resonance spectrum (B) from a patient with obstructive hypertrophic cardiomyopathy (HCM) (case 1, 39-year-old man). Diffuse hypertrophy of the left ventricular wall is observed, although asymmetric septal hypertrophy was shown typically seven years before. Myocardial creatine (3.0 ppm) (arrow) is well preserved in this case (24.7 µmol/g wet weight).
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Figure 5 Representative spin-echo magnetic resonance imaging (A) and cardiac proton magnetic resonance spectrum (B) from a patient with hypertrophic cardiomyopathy (HCM) (case 2, 79-year-old woman). This patient had already advanced to the dilated phase of HCM. A low creatine peak (3.0 ppm) (arrow) is observed (15.6 µmol/g wet weight).
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Figure 6 Individual small plots show the total myocardial CR value measured by proton magnetic resonance in the NML(1) group of controls (open circles), patients in the DCM group (solid circles), and patients in the HCM group (open squares). NML(1) = age-matched normal control group; NML(2) = non–age-matched larger normal control group. Large symbol and vertical bar = mean ± SD. Myocardial CR was significantly lower in the HCM group than in the NML(1) group. Myocardial CR in the HCM group was significantly lower than that in NML(1) group but was significantly higher than that in the DCM group. Abbreviations defined in Figures 3 and 4.
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Figure 7 (Left panel) Correlation between total myocardial creatine (CR) concentrations and left ventricular ejection fraction (EF) in 18 patients with either DCM (solid circles) or HCM (open squares). There was a positive correlation (r = 0.73, p = 0.0006) between the myocardial CR concentrations and left ventricular EF. (Right panel) Correlation between myocardial CR concentrations and plasma B-type natriuretic peptide (BNP) levels in 18 patients with either DCM or HCM. There was a negative correlation (r = –0.54, p = 0.022) between the myocardial CR concentrations and plasma BNP levels. Other abbreviations defined in Figures 3 and 4.
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