Elsevier

JACC: Cardiovascular Imaging

Volume 15, Issue 12, December 2022, Pages 2112-2126
JACC: Cardiovascular Imaging

State-of-the-Art Review
Insights Into the Metabolic Aspects of Aortic Stenosis With the Use of Magnetic Resonance Imaging

https://doi.org/10.1016/j.jcmg.2022.04.025Get rights and content
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Highlights

  • Understanding the cellular pathophysiologic processes in ASmay help to identify patients likely to decompensate early, and to explore potential therapeutic targets that could delay disease progression.

  • Altered cardiac substrate utilization and consequent myocardial steatosis and reduced energy efficiency has been implicated in the transition from compensated hypertrophy to heart failure in AS.

  • Magnetic resonance spectroscopy allows detailed assessment of changes to cardiac substrate and high-energy phosphorous metabolism, improving our understanding of the links between abnormal metabolism and impairment of cardiac function in AS.

Abstract

Pressure overload in aortic stenosis (AS) encompasses both structural and metabolic remodeling and increases the risk of decompensation into heart failure. A major component of metabolic derangement in AS is abnormal cardiac substrate use, with down-regulation of fatty acid oxidation, increased reliance on glucose metabolism, and subsequent myocardial lipid accumulation. These changes are associated with energetic and functional cardiac impairment in AS and can be assessed with the use of cardiac magnetic resonance spectroscopy (MRS). Proton MRS allows the assessment of myocardial triglyceride content and creatine concentration. Phosphorous MRS allows noninvasive in vivo quantification of the phosphocreatine-to-adenosine triphosphate ratio, a measure of cardiac energy status that is reduced in patients with severe AS. This review summarizes the changes to cardiac substrate and high-energy phosphorous metabolism and how they affect cardiac function in AS. The authors focus on the role of MRS to assess these metabolic changes, and potentially guide future (cellular) metabolic therapy in AS.

Key Words

aortic stenosis
cardiac magnetic resonance
magnetic resonance spectroscopy
myocardial metabolism

Abbreviations and Acronyms

ADP
adenosine diphosphate
ATP
adenosine triphosphate
CK
creatine kinase
FAO
fatty acid oxidation
HF
heart failure
LVH
left ventricular hypertrophy
MRS
magnetic resonance spectroscopy
MTG
myocardial triglyceride
PCr
phosphocreatine
PDH
pyruvate dehydrogenase
PPAR
peroxisome proliferator–activated receptor
TCA
tricarboxylic acid

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