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(Circulation. 2001;103:2771.)
© 2001 American Heart Association, Inc.

Editorial

Correlation of Cerebral Metabolites With Clinical Outcome Among Patients With Severe Congestive Heart Failure

Craig R. Malloy, MD

From the Department of Veterans Affairs Medical Center, Dallas, and the Departments of Radiology and Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Tex.

Correspondence to Craig R. Malloy, MD, Mary Nell and Ralph B. Rogers Magnetic Resonance Center, 5801 Forest Park Road, Dallas, TX 75235-9085. E-mail craig.malloy@utsouthwestern.edu

Key Words: Editorials • heart failure • brain • spectroscopy • metabolism • magnetic resonance imaging

Patients with severe congestive heart failure have deranged cognition,^{1 2} and their ability to manage everyday problems is impaired.³ Cardiovascular reflexes, as well as autonomic and endocrine functions that may involve the central nervous system, are also profoundly disrupted. It is therefore of the utmost importance to understand the consequences of severe congestive heart failure for brain function and metabolism. In vivo proton magnetic resonance spectroscopy (¹H MRS) is generating interest for 2 reasons. First, ¹H MRS provides a new probe of cerebral function that measures important brain metabolites by detecting the hydrogen nuclei in these molecules. Furthermore, this examination is becoming widely available, and the patient’s experience is virtually identical to that with conventional MRI.

A large number of biochemical intermediates, neurotransmitters, peptides, and structural molecules could, in principle, be detected by MRS; however, biological factors and current limitations on the MRS experiment limit the number of different signals that may be observed in routine clinical examinations. For example, the concentration of the metabolite must be high, which means that important neurotransmitters (such as dopamine or serotonin) and low-concentration metabolites cannot be observed. Another factor is the molecular weight and physical environment of the compound: ideally, the molecular weight is low and the molecule is freely diffusing in aqueous solution. Large molecules, such as relatively immobile membrane lipids or proteins, do not contribute discrete resonances in the clinical¹H magnetic resonance spectrum. Another factor is the chemical structure itself. Organic molecules contain many hydrogen nuclei in different positions that . . . [Full Text of this Article]

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