MR-Bildgebung und MR-Spektroskopie zur Charakterisierung von Kardiomyopathien bei Jugendlichen - erste Ergebnisse

MRS: a noninvasive window into cardiac metabolism

A well-functioning heart requires a constant supply of a balanced mixture of nutrients to be used for the production of adequate amounts of adenosine triphosphate, which is the main energy source for most cellular functions. Defects in cardiac energy metabolism are linked to several myocardial disorders. MRS can be used to study in vivo changes in cardiac metabolism noninvasively. MR techniques allow repeated measurements, so that disease progression and the response to treatment or to a lifestyle intervention can be monitored. It has also been shown that MRS can predict clinical heart failure and death. This article focuses on in vivo MRS to assess cardiac metabolism in humans and experimental animals, as experimental animals are often used to investigate the mechanisms underlying the development of metabolic diseases. Various MR techniques, such as cardiac (31) P-MRS, (1) H-MRS, hyperpolarized (13) C-MRS and Dixon MRI, are described. A short overview of current and emerging applications is given. Cardiac MRS is a promising technique for the investigation of the relationship between cardiac metabolism and cardiac disease. However, further optimization of scan time and signal-to-noise ratio is required before broad clinical application. In this respect, the ongoing development of advanced shimming algorithms, radiofrequency pulses, pulse sequences, (multichannel) detection coils, the use of hyperpolarized nuclei and scanning at higher magnetic field strengths offer future perspective for clinical applications of MRS.

Cardiac energy metabolism is positively associated with skeletal muscle energy metabolism in physically active adolescents and young adults

31Phosphorus Magnetic Resonance Spectroscopy (31P MRS) is a well-validated, noninvasive magnetic resonance imaging technique that has been used to determine cardiac and skeletal muscle energy metabolism in vivo. Few studies have documented cardiac energy metabolism in adolescents and young adult cohorts. This cross-sectional study sought to explore the association among cardiac energy metabolism, skeletal muscle energy metabolism, moderate-to-vigorous physical activity (MVPA), and age in adolescents and young adults. Ten healthy, active participants (40% male) with a mean ± SD age of 18.6 ± 4.9 years, body mass index of 21.1 ± 2.4 kg·m−2, and median MVPA level of 83 min per weekday (lower quartile: 45 min per weekday; upper quartile: 114 min per weekday) completed the following study assessments: a 31P MRS scan to determine cardiac and skeletal muscle energy metabolism, cardiopulmonary exercise testing to determine aerobic power, and accelerometry to determine MVPA over 7 days. Resting cardiac energy metabolism, as measured by the ratio of phosphocreatine to adenosine triphosphate (PCr/ATPβ, mean ± SD: 2.76 ± 0.65), was positively associated with skeletal muscle aerobic oxidative function (Estimate (SE): −0.1(0.01), p < 0.001), as measured by PCr recovery half-time following 60 s of exercise (34 ± 9 s). This association, which was adjusted for peak aerobic power, MVPA, age, and sex, suggests the development of an association between cardiac and skeletal muscle health at any early age. Larger studies are needed to establish normative data for both physically active and sedentary males and females that may be used for comparison in future studies involving clinical cohorts.

Role of cardiac magnetic resonance in the evaluation of dilated cardiomyopathy: diagnostic contribution and prognostic significance

Dilated cardiomyopathy (DCM) represents the final common morphofunctional pathway of various pathological conditions in which a combination of myocyte injury and necrosis associated with tissue fibrosis results in impaired mechanical function. Recognition of the underlying aetiology of disease and accurate disease monitoring may be crucial to individually optimize therapeutic strategies and stratify patient's prognosis. In this regard, CMR has emerged as a new reference gold standard providing important information for differential diagnosis and new insight about individual risk stratification. The present review article will focus on the role of CMR in the evaluation of present condition, analysing respective strengths and limitations in the light of current literature and technological developments.