From the Hypertension and Diabetes Research Unit, Max Grundig Clinic,
Bühl (W.-I.J., T.H., S.W., M.B., F.v.E., G.J.D.); the Division of
Pediatric Cardiology, University of Tübingen (L.S., J.B., O.S., J.A.);
and the Physikalisches Institut, University of Tübingen (W.-I.J., T.H.,
S.W., O.S., M.B., O.L.), Germany.
Correspondence to Guenther J. Dietze, MD, Hypertension and Diabetes Research Unit, Max Grundig Clinic, D-77815 Bühl, Germany. E-mail dietze{at}max-grundig-clinic.bh.eunet.de
Background—Hypertrophic
cardiomyopathy (HCM) often causes sudden,
unexpected death in adolescents and young adults. Alterations in
myocardial metabolism are considered to be causes for
contractile dysfunction. We examined the question of whether
metabolic abnormalities antedate the manifestation of
symptoms in patients with HCM.
Methods and Results—Proton-decoupled 31P NMR
spectroscopy of the anterior left ventricular wall of the
heart of 14 young, asymptomatic patients with HCM was
performed with a 1.5-T whole-body imager. Spectra of the phosphate
metabolites were compared with those of normal control subjects. The
patients exhibited a significantly reduced (P<0.02)
ratio of phosphocreatine (PCr) to ATP of 1.98±0.37 (mean±SD),
compared with 2.46±0.53 obtained in 11 normal control subjects. In
addition, the group of patients with severe hypertrophy of
the interventricular septum (n=8) showed a significantly
increased (P<0.05) Pi-to-PCr ratio, with a
Pix100/PCr of 20.0±8.3 versus 9.7±7.2 in control
subjects. Both abnormalities are similar to those found in
ischemic myocardium. This view is also supported by
a significantly increased (P<0.01)
phosphomonoester (PME)-to-PCr ratio, with a
PMEx100/PCr of 20.7±11.2 compared with 8.4±6.7 in control subjects,
indicating altered glucose metabolism.
Conclusions—31P NMR spectroscopy detects alterations
of myocardial metabolism in asymptomatic
patients with HCM. These alterations may contribute to the
understanding of the pathophysiology and natural history of the
disease.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
31P NMR Spectroscopy Detects Metabolic Abnormalities in Asymptomatic Patients With Hypertrophic Cardiomyopathy
Key Words: cardiomyopathy • ischemia • metabolism
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