Novel approach helps predict outcomes in heart failure

by Bruce Sylvester – Researchers have developed a new method to predicting which patients with heart failure will do well with treatment and which patients will not.

“While various methods are currently used for prediction, none of these methods are reflective of the underlying mechanism in the weak heart. Furthermore, some of these measures are not very consistent in their predictive ability. There is a need for newer methods which could potentially be more specific and reproducible,” said Gurusher Panjrath, M.D., assistant professor of medicine, director of the Heart Failure and Mechanical Support Program at George Washington University School of Medicine and Health Sciences in Washington, D.C. and an author of the study published on Dec.13, 2013 in  Science Translational Medicine. “By targeting impaired energy metabolism, it may also be possible in the future to develop and tailor therapies to this new target.”

The investigators used using magnetic resonance spectroscopy to measure energy metabolism in 58 heart failure patients with non-ischemic cardiomyopathy, or heart failure not due to blocked arteries.

At baseline, they evaluated measures of adenosine triphosphate (ATP), a source of energy for heart muscle cells, and creatine kinase (CK), an enzyme that interacts with ATP to keep energy supplied in a beating heart. They measured the rate of ATP synthesis through CK, also called “CK flux,” using magnetic resonance spectroscopy.

They tracked the 58 subjects for a median of 4.7 years, recording hospitalizations, heart transplantation, placement of a ventricular assist device and death from all causes.

They reported that baseline measurements of CK flux were significantly lower among the subjects whose condition had eventually worsened.

The authors concluded that this new method of testing energy metabolism in the heart was a significant predictor of clinical outcomes, independent of a patient’s symptoms, race, or strength of the heart.

They noted that larger studies would be necessary in order to validate these results, and that, potentially,  metabolic imaging could be combined with other clinical information to help clinicians make a more complete prediction of heart failure events and death, and improve treatment planning.