1 H-MR spectroscopy for analysis of cardiac lipid and creatine metabolism
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H-MR spectroscopy for analysis of cardiac lipid and creatine metabolism
Kiterie M. E. Faller • Craig A. Lygate • Stefan Neubauer • Ju¨rgen E. Schneider
Ó The Author(s) 2012. This article is published with open access at Springerlink.com
Abstract Magnetic resonance spectroscopy (MRS) is the only non-invasive, non-radiation-based technique for investigating the metabolism of living tissue. MRS of protons (1H-MRS), which provides the highest sensitivity of all MR-visible nuclei, is a method capable of detecting and quantifying specific cardiac biomolecules, such as lipids and creatine in normal and diseased hearts in both animal models and humans. This can be used to study mechanisms of heart failure development in a longitudinal manner, for example, the potential contribution of myocardial lipid accumulation in the context of ageing and obesity. Similarly, quantifying creatine levels provides insight into the energy storage and buffering capacity in the heart. Creatine depletion is consistently observed in heart failure independent of aetiology, but its contribution to pathophysiology remains a matter of debate. These and other questions can in theory be answered with cardiac MRS, but fundamental technical challenges have limited its use. The metabolites studied with MRS are much lower concentration than water protons, requiring methods to suppress the dominant water signal and resulting in larger voxel sizes and longer scan times compared to MRI. However, recent technical advances in MR hardware and software have facilitated the application of 1H-MRS in humans and animal models of heart disease as detailed in this review.
K. M. E. Faller C. A. Lygate S. Neubauer J. E. Schneider (&) Department of Cardiovascular Medicine, British Heart Foundation Experimental Magnetic Resonance Unit (BMRU), Wellcome Trust Centre for Human Genetics, University of Oxford, Roosevelt Drive, Oxford OX3 7BN, UK e-mail: [email protected]
Keywords Heart Metabolism Magnetic resonance spectroscopy 1H-MRS Creatine Lipids
Introduction Heart failure, defined as the inability of the heart to supply sufficient blood flow to meet the needs of the body, is a major societal burden due to its high prevalence, poor prognosis and cost. In the United Kingdom, it affects at least one person out of 100, and this number is anticipated to rise in the next few years [1]. Despite intensive work, the pathogenesis of this multifactorial syndrome—which includes changes in metabolism—is still poorly understood. Every day, the heart consumes—in the form of adenosine triphosphate (ATP)—more energy relative to its weight than any other organ [2–4]. To meet its energy demand, a healthy heart predominantly oxidises free fatty acids (FFA) and glucose. A long-standing hypothesis suggests that the failing heart is energy-starved. However, until the past two decades, this concept—and cardiac metabolism in general—has not really been accessible, mostly due to the lack of techniques to assess metabolic processes of the whole heart in vi
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