Myocardial Lipid and Creatine of Heart Failure on MRS
Condition: Myocardial Lipid
MeSH terms: Heart Failure
Study type: Observational

Summary: 
      The objective of this 3-year project is to develop myocardial MRS, in particular lipid
      (triglyceride) and creatine resonances, as imaging biomarkers for patients with heart failure
      (HF). Investigators will elucidate how and, to what extent, lipid and creatine levels of the
      heart contribute to heart failure. The first year is a cross-sectional study. Investigators
      aim to compare the MRS of normal subjects and that of stable HF patients in recovery with
      normal or impaired ejection fraction (EF). Total 60 subjects will be enrolled, with 20
      subjects in each group. In the 2nd and 3rd years, investigators plan a prospective
      longitudinal study of 40 subjects. Enrolled patients will be evaluated with cardiac MRS at
      three time points, i.e., disease onset, 6 months and one year after treatment, and will be
      followed up until the end of this project (1.5~3-year follow up). In total 120 MR scans will
      be performed in the 2nd and 3rd years. The resonances from cardiac MRS, including creatine
      and lipids, will be correlated with the disease course, patient biochemistry data and
      clinical outcome. Investigators expect to make MRS to become an integral part of a clinical
      cardiac MR protocol.
    

Detailed description: 
      Heart failure (HF) is a major societal burden due to its high prevalence, poor prognosis and
      high cost. A potential therapeutic target is to supply the energy-starved heart. Lipid
      content of the heart is highly dynamic and myocardial lipid overload has been implicated in
      the pathophysiology of cardiac disease. The measurement of total creatine, a crucial actor in
      the creatine kinase system, gives an insight into the energy storage and buffering capacity
      in the heart. Magnetic Resonance Spectroscopy (MRS) is an imaging technique that allows
      non-invasive biochemical analysis in the clinical setting using routine MR scanner. It has
      the combined advantages of inherently providing molecular information, being free of ionizing
      radiation, and not requiring administration of external tracers. The objective of this 3-year
      project is to develop myocardial MRS, in particular lipid (triglyceride) and creatine
      resonances, as imaging biomarkers for patients with heart failure (HF). Investigators will
      elucidate how and, to what extent, lipid and creatine levels of the heart contribute to heart
      failure. The first year is a cross-sectional study. Investigators aim to compare the MRS of
      normal subjects and that of stable HF patients in recovery with normal or impaired ejection
      fraction (EF). Total 60 subjects will be enrolled, with 20 subjects in each group. In the 2nd
      and 3rd years, investigators plan a prospective longitudinal study of 40 subjects. Enrolled
      patients will be evaluated with cardiac MRS at three time points, i.e., disease onset, 6
      months and one year after treatment, and will be followed up until the end of this project
      (1.5~3-year follow up). In total 120 MR scans will be performed in the 2nd and 3rd years. The
      resonances from cardiac MRS, including creatine and lipids, will be correlated with the
      disease course, patient biochemistry data and clinical outcome. Investigators expect to make
      MRS to become an integral part of a clinical cardiac MR protocol. The advance in knowledge is
      to prove the association between heart failure and myocardial impairment in lipids and/or
      creatine. The knowledge gained from MRS could potentially translate as a non-invasive
      biomarker for heart failure patients. This biomarker can help to early detect treatable
      causes of HF, and to monitor and evaluate treatment response in a non-invasive fashion. The
      inherited non-invasiveness and non-radiation nature makes MR an ideal technique for clinical
      application and biotechnology development.
    

Intervention name(s): Proton (1H-) magnetic resonance (MR) spectroscopy
Intervention type(s): Other
Intervention description(s): PRESS localized 1D MRS sequence was used on a 3-T MR system. The lipid resonances will be analyzed using the LC-Model algorithm, and a Cramer-Rao lower bound (CRLB) threshold of 50% was used as quality control. Resonances of fatty acid (FA, lipid resonances δ 0.9, 1.3 and 1.6 ppm) and polyunsaturated fatty acid (PUFA, lipid resonance δ 2.1 and 2.3, 2.8, 5.3 ppm) will be evaluated on MRS, with ratios normalized with total TG value.
Observational model: Case-Only
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Patients with acute HF episode with hospitalization treatment within 12 months were
        enrolled.
      
Keywords: Creatine; heart failure; lipid; MRS; myocardium