Quantifying the effect of dobutamine stress on myocardial Pi and pH in healthy volunteers: A31P MRS study at 7T

Purpose Phosphorus spectroscopy (P-31-MRS) is a proven method to probe cardiac energetics. Studies typically report the phosphocreatine (PCr) to adenosine triphosphate (ATP) ratio. We focus on another(31)P signal: inorganic phosphate (Pi), whose chemical shift allows computation of myocardial pH, with Pi/PCr providing additional insight into cardiac energetics. Pi is often obscured by signals from blood 2,3-diphosphoglycerate (2,3-DPG). We introduce a method to quantify Pi in 14 min without hindrance from 2,3-DPG. Methods Using a(31)P stimulated echo acquisition mode (STEAM) sequence at 7 Tesla that inherently suppresses signal from 2,3-DPG, the Pi peak was cleanly resolved. Resting state UTE-chemical shift imaging (PCr/ATP) and STEAM(31)P-MRS (Pi/PCr, pH) were undertaken in 23 healthy controls; pH and Pi/PCr were subsequently recorded during dobutamine infusion. Results We achieved a clean Pi signal both at rest and stress with good 2,3-DPG suppression. Repeatability coefficient (8 subjects) for Pi/PCr was 0.036 and 0.12 for pH. We report myocardial Pi/PCr and pH at rest and during catecholamine stress in healthy controls. Pi/PCr was maintained during stress (0.098 +/- 0.031 [rest] vs. 0.098 +/- 0.031 [stress]P= .95); similarly, pH did not change (7.09 +/- 0.07 [rest] vs. 7.08 +/- 0.11 [stress]P= .81). Feasibility for patient studies was subsequently successfully demonstrated in a patient with cardiomyopathy. Conclusion We introduced a method that can resolve Pi using 7 Tesla STEAM(31)P-MRS. We demonstrate the stability of Pi/PCr and myocardial pH in volunteers at rest and during catecholamine stress. This protocol is feasible in patients and potentially of use for studying pathological myocardial energetics.

Automated summary

Phosphorus spectroscopy is an effective method for studying cardiac energetics and can provide valuable information about myocardial conditions through the calculation of different phosphorus compound ratios. This study introduces a method to accurately measure Pi by overcoming interference from 2,3-DPG signals, and demonstrates the stability of myocardial Pi/PCr and pH at rest and during stress.