Myocardial high-energy phosphate metabolism and allograft rejection in patients with heart transplants

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To determine whether myocardial high-energy phosphate metabolism is altered in cardiac allograft patients undergoing rejection, 14 patients with heart transplants were examined with image-guided, one-dimensional, phase-encoded surface-coil phosphorus-31 nuclear magnetic resonance (NMR) spectroscopy on 19 occasions 39-2,021 days after transplantation. On average, patients underwent mild rejection (detected with endomyocardial biopsy) and had a reduced ratio of anterior myocardial phosphocreatine (PCr) to adenosine triphosphate (ATP) (1.57 ± 0.50 [standard deviation] vs 1.93 ± 0.2; P < .01) compared with that of 17 healthy control subjects. Ratios of PCr to inorganic phosphate also appeared lower whenever detectable. However, P-31 NMR spectroscopy did not permit reliable identification of patients who required augmented therapy for rejection detected with biopsy either on the day of the P-31 NMR spectroscopic study or at the next scheduled biopsy 10-140 days thereafter (sensitivity, 50%, and specificity, 73% with use of cardiac-averaged PCr/ATP values for each heart; sensitivity, 88%, and specificity, 55% with use of the lowest myocardial PCr/ATP ratios measured in each heart).

Original languageEnglish (US)
Pages (from-to)67-75
Number of pages9
Issue number1
StatePublished - Oct 1991


  • Heart, radionuclide studies, 51.1299
  • Heart, transplantation, 51.459
  • Magnetic resonance (MR), phosphorus studies, 51.1214
  • Magnetic resonance (MR), spectroscopy, 51.1214

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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