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Tsampasian V, Cameron D, Sobhan R, Bazoukis G, Vassiliou VS. Phosphorus Magnetic Resonance Spectroscopy ( 31P MRS) and Cardiovascular Disease: The Importance of Energy. Medicina (B Aires) 2023; 59:medicina59010174. [PMID: 36676798 PMCID: PMC9866867 DOI: 10.3390/medicina59010174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 01/17/2023] Open
Abstract
Background and Objectives: The heart is the organ with the highest metabolic demand in the body, and it relies on high ATP turnover and efficient energy substrate utilisation in order to function normally. The derangement of myocardial energetics may lead to abnormalities in cardiac metabolism, which herald the symptoms of heart failure (HF). In addition, phosphorus magnetic resonance spectroscopy (31P MRS) is the only available non-invasive method that allows clinicians and researchers to evaluate the myocardial metabolic state in vivo. This review summarises the importance of myocardial energetics and provides a systematic review of all the available research studies utilising 31P MRS to evaluate patients with a range of cardiac pathologies. Materials and Methods: We have performed a systematic review of all available studies that used 31P MRS for the investigation of myocardial energetics in cardiovascular disease. Results: A systematic search of the Medline database, the Cochrane library, and Web of Science yielded 1092 results, out of which 62 studies were included in the systematic review. The 31P MRS has been used in numerous studies and has demonstrated that impaired myocardial energetics is often the beginning of pathological processes in several cardiac pathologies. Conclusions: The 31P MRS has become a valuable tool in the understanding of myocardial metabolic changes and their impact on the diagnosis, risk stratification, and prognosis of patients with cardiovascular diseases.
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Affiliation(s)
- Vasiliki Tsampasian
- Norwich Medical School, University of East Anglia, Bob Champion Research & Education Building, Research Park, Rosalind Franklin Rd, Norwich NR4 7UQ, UK
- Correspondence: (V.T.); (V.S.V.)
| | - Donnie Cameron
- C.J. Gorter MRI Center, Department of Radiology, Leiden University Medical Centre, 2333 ZA Leiden, The Netherlands
| | - Rashed Sobhan
- Norwich Medical School, University of East Anglia, Bob Champion Research & Education Building, Research Park, Rosalind Franklin Rd, Norwich NR4 7UQ, UK
| | - George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca 6301, Cyprus
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia 2417, Cyprus
| | - Vassilios S. Vassiliou
- Norwich Medical School, University of East Anglia, Bob Champion Research & Education Building, Research Park, Rosalind Franklin Rd, Norwich NR4 7UQ, UK
- Correspondence: (V.T.); (V.S.V.)
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Ellis J, Valkovič L, Purvis LA, Clarke WT, Rodgers CT. Reproducibility of human cardiac phosphorus MRS ( 31 P-MRS) at 7 T. NMR IN BIOMEDICINE 2019; 32:e4095. [PMID: 30924566 PMCID: PMC6546607 DOI: 10.1002/nbm.4095] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/11/2019] [Accepted: 02/20/2019] [Indexed: 05/12/2023]
Abstract
PURPOSE We test the reproducibility of human cardiac phosphorus MRS (31 P-MRS) at ultra-high field strength (7 T) for the first time. The primary motivation of this work was to assess the reproducibility of a 'rapid' 6½ min 31 P three-dimensional chemical shift imaging (3D-CSI) sequence, which if sufficiently reproducible would allow the study of stress-response processes. We compare this with an established 28 min protocol, designed to record high-quality spectra in a clinically feasible scan time. Finally, we use this opportunity to compare the effect of per-subject B0 shimming on data quality and reproducibility in the 6½ min protocol. METHODS 10 healthy subjects were scanned on two occasions: one to test the 28 min 3D-CSI protocol, and one to test the 6½ min protocol. Spectra were fitted using the OXSA MATLAB toolbox. The phosphocreatine to adenosine triphosphate concentration ratio (PCr/ATP) from each scan was analysed for intra- and intersubject variability. The impact of different strategies for voxel selection was assessed. RESULTS There were no significant differences between repeated measurements in the same subject. For the 28 min protocol, PCr/ATP in the midseptal voxel across all scans was 1.91 ± 0.36 (mean ± intersubject SD). For the 6½ min protocol, PCr/ATP in the midseptal voxel was 1.76 ± 0.40. The coefficients of reproducibility (CRs) were 0.49 (28 min) and 0.67 (6½ min). Per-subject B0 shimming improved the fitted PCr/ATP precision (for 6½ min scans), but had negligible effect on the CR (0.67 versus 0.66). CONCLUSIONS Both 7 T protocols show improved reproducibility compared with a previous 3 T study by Tyler et al. Our results will enable informed power calculations and protocol selection for future clinical research studies.
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Affiliation(s)
- Jane Ellis
- OCMR, RDM Cardiovascular MedicineUniversity of OxfordUK
| | - Ladislav Valkovič
- OCMR, RDM Cardiovascular MedicineUniversity of OxfordUK
- Slovak Academy of SciencesInstitute of Measurement ScienceBratislavaSlovakia
| | | | - William T. Clarke
- OCMR, RDM Cardiovascular MedicineUniversity of OxfordUK
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical NeurosciencesUniversity of OxfordUK
| | - Christopher T. Rodgers
- OCMR, RDM Cardiovascular MedicineUniversity of OxfordUK
- Wolfson Brain Imaging Centre, Department of Clinical NeurosciencesUniversity of CambridgeUK
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Vidya Shankar R, Chang JC, Hu HH, Kodibagkar VD. Fast data acquisition techniques in magnetic resonance spectroscopic imaging. NMR IN BIOMEDICINE 2019; 32:e4046. [PMID: 30637822 DOI: 10.1002/nbm.4046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 10/30/2018] [Accepted: 10/31/2018] [Indexed: 06/09/2023]
Abstract
Magnetic resonance spectroscopic imaging (MRSI) is an important technique for assessing the spatial variation of metabolites in vivo. The long scan times in MRSI limit clinical applicability due to patient discomfort, increased costs, motion artifacts, and limited protocol flexibility. Faster acquisition strategies can address these limitations and could potentially facilitate increased adoption of MRSI into routine clinical protocols with minimal addition to the current anatomical and functional acquisition protocols in terms of imaging time. Not surprisingly, a lot of effort has been devoted to the development of faster MRSI techniques that aim to capture the same underlying metabolic information (relative metabolite peak areas and spatial distribution) as obtained by conventional MRSI, in greatly reduced time. The gain in imaging time results, in some cases, in a loss of signal-to-noise ratio and/or in spatial and spectral blurring. This review examines the current techniques and advances in fast MRSI in two and three spatial dimensions and their applications. This review categorizes the acceleration techniques according to their strategy for acquisition of the k-space. Techniques such as fast/turbo-spin echo MRSI, echo-planar spectroscopic imaging, and non-Cartesian MRSI effectively cover the full k-space in a more efficient manner per TR . On the other hand, techniques such as parallel imaging and compressed sensing acquire fewer k-space points and employ advanced reconstruction algorithms to recreate the spatial-spectral information, which maintains statistical fidelity in test conditions (ie no statistically significant differences on voxel-wise comparisions) with the fully sampled data. The advantages and limitations of each state-of-the-art technique are reviewed in detail, concluding with a note on future directions and challenges in the field of fast spectroscopic imaging.
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Affiliation(s)
- Rohini Vidya Shankar
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
| | - John C Chang
- Banner M D Anderson Cancer Center, Gilbert, AZ, USA
- School for Engineering of Matter, Transport and Energy, Arizona State University, Tempe, AZ, USA
| | - Houchun H Hu
- Department of Radiology and Medical Imaging, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Vikram D Kodibagkar
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ, USA
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Scally C, Rudd A, Mezincescu A, Wilson H, Srivanasan J, Horgan G, Broadhurst P, Newby DE, Henning A, Dawson DK. Persistent Long-Term Structural, Functional, and Metabolic Changes After Stress-Induced (Takotsubo) Cardiomyopathy. Circulation 2017; 137:1039-1048. [PMID: 29128863 PMCID: PMC5841855 DOI: 10.1161/circulationaha.117.031841] [Citation(s) in RCA: 176] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/23/2017] [Indexed: 12/12/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Takotsubo cardiomyopathy is an increasingly recognized acute heart failure syndrome precipitated by intense emotional stress. Although there is an apparent rapid and spontaneous recovery of left ventricular ejection fraction, the long-term clinical and functional consequences of takotsubo cardiomyopathy are ill-defined. Methods: In an observational case-control study, we recruited 37 patients with prior (>12-month) takotsubo cardiomyopathy, and 37 age-, sex-, and comorbidity-matched control subjects. Patients completed the Minnesota Living with Heart Failure Questionnaire. All participants underwent detailed clinical phenotypic characterization, including serum biomarker analysis, cardiopulmonary exercise testing, echocardiography, and cardiac magnetic resonance including cardiac 31P-spectroscopy. Results: Participants were predominantly middle-age (64±11 years) women (97%). Although takotsubo cardiomyopathy occurred 20 (range 13–39) months before the study, the majority (88%) of patients had persisting symptoms compatible with heart failure (median of 13 [range 0–76] in the Minnesota Living with Heart Failure Questionnaire) and cardiac limitation on exercise testing (reduced peak oxygen consumption, 24±1.3 versus 31±1.3 mL/kg/min, P<0.001; increased VE/Vco2 slope, 31±1 versus 26±1, P=0.002). Despite normal left ventricular ejection fraction and serum biomarkers, patients with prior takotsubo cardiomyopathy had impaired cardiac deformation indices (reduced apical circumferential strain, −16±1.0 versus −23±1.5%, P<0.001; global longitudinal strain, −17±1 versus −20±1%, P=0.006), increased native T1 mapping values (1264±10 versus 1184±10 ms, P<0.001), and impaired cardiac energetic status (phosphocreatine/γ-adenosine triphosphate ratio, 1.3±0.1 versus 1.9±0.1, P<0.001). Conclusions: In contrast to previous perceptions, takotsubo cardiomyopathy has long-lasting clinical consequences, including demonstrable symptomatic and functional impairment associated with persistent subclinical cardiac dysfunction. Taken together our findings demonstrate that after takotsubo cardiomyopathy, patients develop a persistent, long-term heart failure phenotype. Clinical Trial Registration: URL: https://clinicaltrials.gov. Unique identifier: NCT02989454.
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Affiliation(s)
- Caroline Scally
- Aberdeen Cardiovascular and Diabetes Research Centre, University of Aberdeen, United Kingdom (C.S., A.R., A.M., H.W., J.S., P.B., D.K.D.).
| | - Amelia Rudd
- Aberdeen Cardiovascular and Diabetes Research Centre, University of Aberdeen, United Kingdom (C.S., A.R., A.M., H.W., J.S., P.B., D.K.D.)
| | - Alice Mezincescu
- Aberdeen Cardiovascular and Diabetes Research Centre, University of Aberdeen, United Kingdom (C.S., A.R., A.M., H.W., J.S., P.B., D.K.D.)
| | - Heather Wilson
- Aberdeen Cardiovascular and Diabetes Research Centre, University of Aberdeen, United Kingdom (C.S., A.R., A.M., H.W., J.S., P.B., D.K.D.)
| | - Janaki Srivanasan
- Aberdeen Cardiovascular and Diabetes Research Centre, University of Aberdeen, United Kingdom (C.S., A.R., A.M., H.W., J.S., P.B., D.K.D.)
| | - Graham Horgan
- Department of Biomathematics and Statistics Scotland, Aberdeen, United Kingdom (G.H.)
| | - Paul Broadhurst
- Aberdeen Cardiovascular and Diabetes Research Centre, University of Aberdeen, United Kingdom (C.S., A.R., A.M., H.W., J.S., P.B., D.K.D.)
| | - David E Newby
- Department of Cardiovascular Sciences, University of Edinburgh, United Kingdom (D.E.N.)
| | - Anke Henning
- Department of Biomedical Imaging, University of Greifswald, Germany (A.H.)
| | - Dana K Dawson
- Aberdeen Cardiovascular and Diabetes Research Centre, University of Aberdeen, United Kingdom (C.S., A.R., A.M., H.W., J.S., P.B., D.K.D.)
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Weiss K, Martini N, Boesiger P, Kozerke S. Metabolic MR imaging of regional triglyceride and creatine content in the human heart. Magn Reson Med 2012; 68:1696-704. [PMID: 22294511 DOI: 10.1002/mrm.24178] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 12/19/2011] [Accepted: 12/22/2011] [Indexed: 11/08/2022]
Abstract
An optimized echo-planar spectroscopic imaging sequence is proposed to facilitate spatial mapping of triglyceride and total creatine content in the human heart. The sequence integrates local-look field of view reduction, cardiac and respiratory gating, and dedicated reconstruction steps to account for gradient channel delays, field inhomogeneity, and phase incoherence due to residual motion. The technique is demonstrated in 12 volunteers in comparison to single voxel point-resolved spectroscopy in the septal wall at 1.5 T. Triglyceride-to-water and total creatine-to-water ratios derived from echo-planar spectroscopic imaging (0.48 ± 0.18% and 0.06 ± 0.03%) and point-resolved spectroscopy (0.52 ± 0.17% and 0.07 ± 0.02%) were found to agree well. In the septal region, intraclass correlation coefficients ranging from 0.67 to 0.72 were estimated. A relatively weak agreement (intraclass correlation coefficients: 0.34 and 0.52) was found for sectors in the lateral wall due to field gradients induced by the posterior vein and limited sensitivity of the receive coil array in this area. On the basis of the findings, it is concluded that fast spectroscopic imaging of both cardiac triglyceride and total creatine content is feasible. Shimming and sensitivity challenges in the lateral region remain, however, to be addressed.
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Affiliation(s)
- Kilian Weiss
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
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Bogner W, Chmelik M, Andronesi OC, Sorensen AG, Trattnig S, Gruber S. In vivo 31P spectroscopy by fully adiabatic extended image selected in vivo spectroscopy: a comparison between 3 T and 7 T. Magn Reson Med 2011; 66:923-30. [PMID: 21446033 DOI: 10.1002/mrm.22897] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Revised: 02/01/2011] [Accepted: 02/06/2011] [Indexed: 01/11/2023]
Abstract
An improved image selected in vivo spectroscopy (ISIS) sequence for localized (31)P magnetic resonance spectroscopy at 7 T was developed. To reduce errors in localization accuracy, adiabatic excitation, gradient offset independent adiabatic inversion pulses, and a special extended ISIS ordering scheme were used. The localization accuracy of extended ISIS was investigated in phantoms. The possible spectral quality and reproducibility in vivo was explored in a volunteer (brain, muscle, and liver). A comparison between 3 T and 7 T was performed in five volunteers. Adiabatic extended ISIS provided high spectral quality and accurate localization. The contamination in phantom experiments was only ∼5%, even if a pulse repetition time ∼ 1.2·T(1) was chosen to maximize the signal-to-noise ratio per unit time. High reproducibility was found in the calf muscle for 2.5 cm isotropic voxels at 7 T. When compared with 3 T, localized (31)P magnetic resonance spectroscopy in the human calf muscle at 7 T provided ∼3.2 times higher signal-to-noise ratio (as judged from phosphocreatine peak amplitude in frequency domain after matched filtering). At 7 T, extended ISIS allowed the performance of high-quality localized (31)P magnetic resonance spectroscopy in a short measurement time (∼3 to 4 min) and isotropic voxel sizes of ∼2.5 to 3 cm. With such short measurement times, localized (31)P magnetic resonance spectroscopy has the potential to be applied not only for clinical research but also for routine clinical practice.
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Affiliation(s)
- W Bogner
- Department of Radiology, MR Center of Excellence, Medical University Vienna, Vienna, Austria
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Burkhard T, Herzog C, Linzbach S, Spyridopoulos I, Huebner F, Vogl TJ. Cardiac 31P-MRS compared to echocardiographic findings in patients with hypertensive heart disease without overt systolic dysfunction—Preliminary results. Eur J Radiol 2009; 71:69-74. [DOI: 10.1016/j.ejrad.2008.03.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Revised: 03/11/2008] [Accepted: 03/12/2008] [Indexed: 10/22/2022]
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