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31P-MR spectroscopic imaging in hypertensive heart disease
J-P Heyne1, R Rzanny, A Hansch
1Institute of Diagnostic and Interventional Radiology, Friedrich Schiller University, Erlanger Allee 101, 07747 Jena, Germany. Jens-Peter.Heyne@med.uni-jena.de
Insights
Hypertensive heart disease (HHD) impairs cardiac energy metabolism, particularly in patients with systolic dysfunction. Phosphorus-31 magnetic resonance spectroscopy (31P-MRS) revealed reduced phosphocreatine to ATP ratios, correlating with impaired left ventricular ejection fraction.
Area of Science:
- Cardiology
- Biochemistry
- Medical Imaging
Background:
- Hypertensive heart disease (HHD) leads to structural changes, including fibrosis, causing diastolic and systolic myocardial dysfunction.
- Cardiac energy metabolism alterations are implicated in the progression of HHD and its functional consequences.
Purpose of the Study:
- To assess alterations in phosphorus-31 (31P) metabolism and cardiac energy in HHD patients using magnetic resonance spectroscopy (MRS).
- To correlate these metabolic changes with left ventricular systolic function.
Main Methods:
- Utilized 31P-MRS at 1.5 T with an ECG-gated CSI sequence in 36 HHD patients and 20 healthy controls.
- Categorized HHD patients into those with diastolic dysfunction (HHD-D) and those with additional systolic dysfunction (HHD-S).
- Analyzed phosphocreatine (PCr) to gamma-ATP and phosphodiester (PDE) to gamma-ATP ratios.
Main Results:
- Both HHD groups showed lower PCr/gamma-ATP ratios than controls. HHD-S patients had lower ratios than HHD-D patients (1.43 vs. 1.65).
- PCr/gamma-ATP ratios linearly correlated with left ventricular ejection fraction (LVEF) (r=0.39, P=0.025).
- HHD-S patients exhibited significantly lower PDE/gamma-ATP ratios compared to controls (0.56 vs. 1.14), indicating altered phospholipid metabolism.
Conclusions:
- Distinct metabolic changes in HHD-S patients suggest altered energy metabolism, unlike HHD-D patients where changes might be age-related.
- Observed metabolic alterations, including reduced PCr/gamma-ATP and PDE/ATP ratios, are linked to functional impairments like reduced LVEF in HHD.
- 31P-MRS is a valuable tool for assessing cardiac energy metabolism and its relationship to functional decline in hypertensive heart disease.
Abstract:
Hypertensive heart disease (HHD) causes structural changes (e.g., fibrosis) that result in diastolic and systolic myocardial dysfunction. Alterations of (31)P metabolism and cardiac energy impairments were assessed in patients with HHD by MR spectroscopy (MRS) and correlated with left ventricular systolic function. Thirty-six patients with HHD and 20 healthy controls (mean age 35.2+/-10.7 years) were examined with (31)P-MRS at 1.5 T by using an ECG-gated CSI sequence. Twenty-five patients (mean age 64.3+/-9.3 years) had diastolic dysfunction, but preserved systolic function (HHD-D), whereas 11 patients (62.3+/-11.4 years) suffered from additional impaired systolic function (HHD-S). In both patient groups, the PCr/gamma-ATP ratio was lower than in the controls (controls: 2.07+/-0.17; P<0.001), and in HHD-S was lower than in HHD-D (1.43+/-0.21 vs. 1.65+/-0.25; P=0.012). PCr/gamma-ATP ratios were linearly correlated with LVEF (Pearson's r: 0.39; P=0.025). In the HHD-S group, the PDE/gamma-ATP ratio was significantly lower (0.56+/-0.36) than in the controls (1.14+/-0.42; P=0.001). In contrast to the group of HHD-D patients, whose slightly decreased PCr/gamma-ATP ratios compared to controls may be explained by age differences, the more distinct changes observed in HHD-S patients indicate an altered energy metabolism. The observed metabolic changes were related to functional impairments, as indicated by a reduced LVEF. Reduced PDE/ATP ratios indicate changes in the phospholipid metabolism.
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