(Circulation. 1997;96:2190-2196.)
© 1997 American Heart Association, Inc.
Articles |
Myocardial Phosphocreatine-to-ATP Ratio Is a Predictor of Mortality in Patients With Dilated Cardiomyopathy
From the Departments of Medicine and Radiology (S.N., M.H., M.C., K.H., W.P., T.P., G.E., D.H., K.K.), Würzburg University, Germany; the Cardiac Computer Center, Massachusetts General Hospital, Boston (J.B.N.); and the NMR Laboratory for Physiological Chemistry (J.S.I.), Harvard Medical School, Boston Mass. Dr Ertl's present address is II Medizinischen Klinik, Klinikum Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer, 68135 Mannheim, Germany.
Correspondence to Stefan Neubauer, MD, Medizinische Universitätsklinik, Josef-Schneider-Straße 2, 97080 Würzburg, Germany. E-mail s.neubauer{at}rzbox.uni-wuerzburg.de
Background In patients with heart failure due to dilated cardiomyopathy, cardiac energy metabolism is impaired, as indicated by a reduction of the myocardial phosphocreatine-to-ATP ratio, measured noninvasively by 31P-MR spectroscopy. The purpose of this study was to test whether the phosphocreatine-to-ATP ratio also offers prognostic information in terms of mortality prediction as well as how this index compares with well-known mortality predictors such as left ventricular ejection fraction (LVEF) or New York Heart Association (NYHA) class.
Methods and Results Thirty-nine patients with dilated cardiomyopathy were followed up for 928±85 days (2.5 years). At study entry, LVEF and NYHA class were determined, and the cardiac phosphocreatine-to-ATP ratio was measured by localized 31P-MR spectroscopy of the anterior myocardium. During the study period, total mortality was 26%. Patients were divided into two groups, one with a normal phosphocreatine-to-ATP ratio (>1.60; mean±SE, 1.98±0.07; n=19; healthy volunteers: 1.94±0.11, n=30) and one with a reduced phosphocreatine-to-ATP ratio (<1.60; 1.30±0.05; n=20). At reevaluation (mean, 2.5 years), 8 of 20 patients with reduced phosphocreatine-to-ATP ratios had died, all of cardiovascular causes (total and cardiovascular mortality, 40%). Of the 19 patients with normal phosphocreatine-to-ATP ratios, 2 had died (total mortality, 11%), one of cardiovascular causes (cardiovascular mortality, 5%). Kaplan-Meier analysis showed significantly reduced total (P=.036) and cardiovascular (P=.016) mortality for patients with normal versus patients with low phosphocreatine-to-ATP ratios. A Cox model for multivariate analysis showed that the phosphocreatine-to-ATP ratio and NYHA class offered significant independent prognostic information on cardiovascular mortality.
Conclusions The myocardial phosphocreatine-to-ATP ratio, measured noninvasively with 31P-MR spectroscopy, is a predictor of both total and cardiovascular mortality in patients with dilated cardiomyopathy.
Key Words: spectroscopy, magnetic resonance • mortality • heart failure • metabolism
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