Proton magnetic resonance spectroscopy can detect creatine depletion associated with the progression of heart failure in cardiomyopathy

This study noninvasively examined total creatine (CR) of the myocardium in dilated cardiomyopathy (DCM) or hypertrophic cardiomyopathy (HCM) using proton magnetic resonance spectroscopy (1H-MRS). Abnormalities in CR metabolism in failing hearts have been reported. A biochemical study suggested that myocardial metabolic changes are very similar in DCM and HCM despite the different heart failure (HF) mechanisms. Using cardiac-gated 1H-MRS with magnetic resonance image (MRI)-guided point-resolved spectroscopy (PRESS) localization, we quantitatively measured septal CR. Patients with either DCM (n = 11) or HCM (n = 7) and age-matched normal subjects (n = 14) were examined. Myocardial CR was significantly lower in DCM patients (16.1 ± 4.5 μmol/g wet weight [range 10.2 to 22.9], p < 0.05) than that in subjects with normal hearts (27.6 ± 4.1 μmol/g [range 21.4 to 36.2]). Myocardial CR in HCM patients (22.6 ± 8.1 μmol/g [range 12.2 to 34.5]) was significantly lower than that in subjects with normal hearts (p < 0.05) but was significantly higher than that in DCM patients (p < 0.05). In 18 patients with either DCM or HCM, myocardial CR correlated positively with left ventricular ejection fraction (LVEF) (y = 0.22x + 9.8, r = 0.73, p = 0.0006) but correlated negatively with plasma B-type natriuretic peptide (BNP) levels (y = −0.012x + 22.4, r = −0.54, p = 0.022). This study showed that 1H-MRS can noninvasively detect CR depletion associated with the severity of HF in cardiomyopathy.