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Magnetic Resonance Spectroscopy in Myocardial Disease

Department of Cardiovascular Medicine, John Radcliffe Hospital, Oxford, United Kingdom

^_* Reprint requests and correspondence: Dr. Stefan Neubauer, John Radcliffe Hospital, University of Oxford, Cardiovascular Medicine, Headley Way, Oxford, Oxfordshire OX3 9DU, United Kingdom (Email: stefan.neubauer{at}cardiov.ox.ac.uk).

Magnetic resonance spectroscopy (MRS) is the only noninvasive, nonradiation exposure technique for the investigation of cardiac metabolism in vivo. MRS uses magnetic resonance signals from nuclei, such as ³¹phosphorus, ¹hydrogen, and ²³sodium, to provide comprehensive metabolic and biochemical information about cardiac muscle. This method is highly versatile and can provide metabolic insights into the role of cardiac metabolism, in particular, cardiac energetics, in a wide number of conditions, including hypertensive, valvular, and ischemic heart disease, heart failure, and cardiac transplantation, as well as cardiomyopathies. This method can also be used to monitor patient responses to therapeutic interventions: pharmacologic, surgical, or interventional. When combined with cardiovascular magnetic resonance imaging, MRS enables detailed pathophysiologic insights into the inter-relations among cardiac structure, function, perfusion, and metabolism. However, MRS is currently used primarily as a research tool because of low temporal and spatial resolution and low reproducibility. It is hoped that future technical developments and use of higher magnetic field strengths (such as 7-T) may enable application of cardiac MRS in clinical practice.

Key Words: magnetic resonance spectroscopy • high-energy phosphates • adenosine triphosphate • phosphocreatine • noninvasive metabolic imaging • ³¹P spectroscopy • cardiac energetics

Abbreviations and Acronyms   ATP = adenosine triphosphate   CK = creatine kinase   CMR = cardiovascular magnetic resonance imaging   HCM = hypertrophic cardiomyopathy   MRS = magnetic resonance spectroscopy   NYHA = New York Heart Association   31P-MRS = 31phosphorus-magnetic resonance spectroscopy   PCr/ATP = phosphocreatine-to-adenosine triphosphate   3D-CSI = 3-dimensional chemical shift imaging