Neubauer S, Krahe T, Schindler R, Horn M, Hillenbrand H, Entzeroth C, Mader H, Kromer E P, Riegger G A, Lackner K
Department of Medicine, Würzburg University, FRG.
Circulation. 1992 Dec;86(6):1810-8. doi: 10.1161/01.cir.86.6.1810.
The purpose of this work was to further define the value of cardiac 31P magnetic resonance (MR) spectroscopy for patients with coronary artery disease and dilated cardiomyopathy.
Blood-corrected and T1-corrected 31P MR spectra of anteroseptal myocardium were obtained at rest using image-selected in vivo spectroscopy localization, a selected volume of 85 +/- 12 cm3, and a field strength of 1.5 T. Nineteen volunteers had a creatine phosphate (CP)/ATP ratio of 1.95 +/- 0.45 (mean +/- SD) and a PDE/ATP ratio of 1.06 +/- 0.53; in four patients with left anterior descending coronary artery (LAD) stenosis, six patients with chronic anterior wall infarction, and four patients with chronic posterior wall infarction, CP/ATP and phosphodiester (PDE)/ATP ratios did not differ from those in volunteers. Twenty-five measurements of 19 patients with dilated cardiomyopathy yielded a CP/ATP of 1.78 +/- 0.51 and a PDE/ATP of 0.98 +/- 0.56 (p = NS versus volunteers). When these patients were grouped according to the severity of heart failure, however, CP/ATP was 1.94 +/- 0.43 in mild (p = NS versus volunteers) and 1.44 +/- 0.52 in severe DCM (p < 0.05), respectively. No correlation was found between CP/ATP and left ventricular ejection fraction or fractional shortening, but correlation of CP/ATP with the New York Heart Association (NYHA) class was significant (r = 0.60, p < 0.005). Six patients with dilated cardiomyopathy were studied repeatedly before and after 12 +/- 6 weeks of drug treatment leading to clinical recompensation with improvement of the NYHA status by 0.8 +/- 0.3 classes. Concomitantly, CP/ATP increased from 1.51 +/- 0.32 to 2.15 +/- 0.27 (p < 0.01), whereas PDE/ATP did not change significantly.
Cardiac high-energy phosphate metabolism at rest is normal in LAD stenosis and chronic myocardial infarction in the absence of heart failure. The CP/ATP ratio has low specificity for the diagnosis of dilated cardiomyopathy. However, CP/ATP correlated with the clinical severity of heart failure and may improve during clinical recompensation.
本研究旨在进一步明确心脏³¹P磁共振波谱对冠心病和扩张型心肌病患者的价值。
采用体内磁共振波谱成像定位技术，在静息状态下获取前间隔心肌经血液校正和T1校正的³¹P磁共振波谱，选定容积为85±12 cm³，场强为1.5 T。19名志愿者的磷酸肌酸（CP）/三磷酸腺苷（ATP）比值为1.95±0.45（均值±标准差），磷酸二酯（PDE）/ATP比值为1.06±0.53；4例左前降支冠状动脉（LAD）狭窄患者、6例慢性前壁梗死患者和4例慢性后壁梗死患者的CP/ATP及PDE/ATP比值与志愿者无差异。19例扩张型心肌病患者的25次测量结果显示，CP/ATP为1.78±0.51，PDE/ATP为0.98±0.56（与志愿者相比，p =无显著性差异）。然而，根据心力衰竭严重程度对这些患者进行分组时，轻度患者的CP/ATP为1.94±0.43（与志愿者相比，p =无显著性差异），重度扩张型心肌病患者的CP/ATP为1.44±0.52（p < 0.05）。未发现CP/ATP与左心室射血分数或缩短分数之间存在相关性，但CP/ATP与纽约心脏协会（NYHA）心功能分级之间存在显著相关性（r = 0.60，p < 0.005）。对6例扩张型心肌病患者在药物治疗12±6周前后进行了重复研究，治疗后临床症状得到改善，NYHA心功能分级提高了0.8±0.3级。同时，CP/ATP从1.51±0.32增加至2.15±0.27（p < 0.01），而PDE/ATP无显著变化。
在无心力衰竭的情况下，LAD狭窄和慢性心肌梗死患者静息时的心脏高能磷酸代谢正常。CP/ATP比值对扩张型心肌病的诊断特异性较低。然而，CP/ATP与心力衰竭的临床严重程度相关，且在临床症状改善过程中可能升高。
