Neubauer S, Horn M, Pabst T, Gödde M, Lübke D, Jilling B, Hahn D, Ertl G
Department of Internal Medicine, Würzburg University, Germany.
Eur Heart J. 1995 Dec;16 Suppl O:115-8. doi: 10.1093/eurheartj/16.suppl_o.115.
In the present work, we studied clinical and haemodynamic correlates of impaired cardiac high-energy phosphate metabolism in patients with heart failure due to dilated cardiomyopathy (DCM). Myocardial 31P-magnetic resonance (MR) spectra were obtained at 1.5 T in 14 volunteers and 23 patients with DCM (mean ejection fraction 34%) in order to quantify the creatine phosphate (CP)/ATP ratio. In addition, patients underwent cardiac catheterization and echocardiography. Compared to volunteers (2.02 +/- 0.11), CP/ATP ratios were significantly reduced in DCM patients (1.54 +/- 0.10; P < 0.05), indicating impaired high-energy phosphate metabolism. CP/ATP ratios correlated with the clinical severity of heart failure estimated from the NYHA class (r = 0.47, P < 0.01); also, CP/ATP correlated with left ventricular ejection fraction (r = 0.54, P < 0.01) and left ventricular end-diastolic wall thickness (r = 0.51, P < 0.01). Thus, 31P-MR spectroscopy can detect abnormal cardiac high-energy phosphate metabolism in patients with heart failure due to DCM. These abnormalities correlate with clinical and haemodynamic parameters. Future studies will have to determine whether 31P-MR spectroscopy can contribute to the routine clinical evaluation of patients with heart failure.
在本研究中，我们探讨了扩张型心肌病（DCM）所致心力衰竭患者心脏高能磷酸代谢受损的临床及血流动力学相关因素。在1.5T条件下，对14名志愿者和23名DCM患者（平均射血分数34%）进行了心肌31P磁共振（MR）波谱分析，以定量磷酸肌酸（CP）/三磷酸腺苷（ATP）比值。此外，患者还接受了心导管检查和超声心动图检查。与志愿者（2.02±0.11）相比，DCM患者的CP/ATP比值显著降低（1.54±0.10；P<0.05），提示高能磷酸代谢受损。CP/ATP比值与根据纽约心脏协会（NYHA）分级评估的心力衰竭临床严重程度相关（r=0.47，P<0.01）；此外，CP/ATP比值还与左心室射血分数（r=0.54，P<0.01）和左心室舒张末期壁厚（r=0.51，P<0.01）相关。因此，31P-MR波谱分析可检测DCM所致心力衰竭患者心脏高能磷酸代谢异常。这些异常与临床及血流动力学参数相关。未来研究需确定31P-MR波谱分析是否有助于心力衰竭患者的常规临床评估。
