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Detection of myocardial disorders by magnetic resonance spectroscopy

Nature Clinical Practice Cardiovascular Medicine volume 5, pages S49–S56 (2008)Cite this article

Abstract

Magnetic resonance spectroscopy (MRS) utilizes magnetic resonance signals from nuclei, such as phosphorus-31, to provide information regarding the biochemical composition and metabolic state of cardiac muscle. This technique is the only method available for noninvasive assessment of cardiac metabolism without the need for the application of external radioactive tracers. MRS provides insights into the role of cardiac energetics in ischemic heart disease, heart failure, hypertrophy, and valve disease. Furthermore, response to therapeutic intervention can be monitored using this method. At present, this technique is used as a research tool, because low spatial and temporal resolution, as well as low reproducibility, precludes its diagnostic use in clinical practice; however, higher-field magnetic resonance systems—using, for example, 7 T—will enable improvements in resolution and reproducibility that may take cardiac MRS into the clinical realm.

Key Points

  • Magnetic resonance spectroscopy with phosphorus-31 (31P-MRS) utilizes the nuclear spin of 31P and is the only available method for the noninvasive assessment of cardiac metabolism without need for the application of external radioactive tracers

  • Energetic derangement of the heart in dilated cardiomyopathy predicts prognosis and correlates with left ventricular ejection fraction and NYHA class; improvements in cardiac energetics following pharmacological therapy can be seen using 31P-MRS

  • 31P-MRS can differentiate pathological and physiological hypertrophy

  • 31P-MRS stress testing can identify exercise-induced ischemia

  • Increased field strengths, such as 3 T or greater, will increase the signal to noise ratio, and will improve the clinical application of 31P-MRS

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Figure 1: Schematic diagram of a human cardiac MRS study.
Figure 2: 31P-magnetic resonance spectroscopy in a healthy volunteer.
Figure 3: The creatine kinase phosphocreatine energy shuttle.
Figure 4: Kaplan–Meier life table analysis for total mortality of patients with dilated cardiomyopathy, divided into two groups according to their myocardial phosphocreatine to ATP ratio (<1.60 vs >1.60).
Figure 5: 31P spectra and PCr to ATP ratios in healthy volunteers and patients with HCM.
Figure 6: Phosphocreatine to ATP ratios at rest, and during handgrip exercise and recovery.

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Author information

Authors and Affiliations

  1. LE Hudsmith is a Specialist Registrar in Cardiology at the Queen Elizabeth Hospital, Birmingham and at the John Radcliffe Hospital, Oxford,

    Lucy E Hudsmith

  2. S Neubauer is Professor of Cardiovascular Medicine at the Department of Cardiovascular Medicine, John Radcliffe Hospital, and is Clinical Director of the University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, UK.,

    Stefan Neubauer

Authors
  1. Lucy E Hudsmith
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  2. Stefan Neubauer
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Correspondence to Stefan Neubauer.

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The authors declare no competing financial interests.

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Hudsmith, L., Neubauer, S. Detection of myocardial disorders by magnetic resonance spectroscopy. Nat Rev Cardiol 5 (Suppl 2), S49–S56 (2008). https://doi.org/10.1038/ncpcardio1158

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