Jan A. Den Hollander

Prognosis in Women With Myocardial Ischemia in the Absence of Obstructive Coronary Disease Results From the National Institutes of Health–National Heart, Lung, and Blood Institute–Sponsored Women’s Ischemia Syndrome Evaluation (WISE)

Background—We previously reported that 20% of women with chest pain but without obstructive coronary artery disease (CAD) had stress-induced reduction in myocardial phosphocreatine–adenosine triphosphate ratio by phosphorus-31 nuclear magnetic resonance spectroscopy (abnormal MRS), consistent with myocardial ischemia. The prognostic implications of these findings are unknown. Methods and Results—Women referred for coronary angiography for suspected myocardial ischemia underwent MRS handgrip stress testing and follow-up evaluation. These included (1) n= 60 with no CAD/normal MRS, (2) n= 14 with no CAD/abnormal MRS, and (3) n= 352 a reference group with CAD. Cardiovascular events were death, myocardial infarction, heart failure, stroke, other vascular events, and hospitalization for unstable angina. Cumulative freedom from events at 3 years was 87%, 57%, and 52% for women with no CAD/normal MRS, no CAD/abnormal MRS, and CAD, respectively (P < 0.01). After adjusting for CAD and cardiac risk factors, a phosphocreatine–adenosine triphosphate ratio decrease of 1% increased the risk of a cardiovascular event by 4% (P = 0.02). The higher event rate in women with no CAD/abnormal MRS was primarily due to hospitalization for unstable angina, which is associated with repeat catheterization and higher healthcare costs. Conclusions—Among women without CAD, abnormal MRS consistent with myocardial ischemia predicted cardiovascular outcome, notably higher rates of anginal hospitalization, repeat catheterization, and greater treatment costs. Further evaluation into the underlying pathophysiology and possible treatment options for women with evidence of myocardial ischemia but without CAD is indicated.

1H NMR Spectroscopy and Spectroscopic Imaging of The Human Brain

The first high field 1H NMR spectroscopy studies of the animal brain were performed in 1983 [1]. These studies showed that 1H NMR spectroscopy allows in vivo observation of a number of brain compounds, including different aminoacids, creatine, choline residues, and—under certain perturbations—of lactate. Those initial studies have given rise to a large number of studies which apply 1H NMR spectroscopy to different aspects of brain metabolism, under different kind of perturbations [2]. These studies have shown that a wealth of information can be obtained about cerebral metabolism and physiology by 1H NMR spectroscopy of the animal brain.

Method and device for the volume-selective extraction of a magnetic resonance spectrum by Hartmann-Hahn transfer

An object is placed within the field of magnetic coils which generate a steady uniform magnetic field. The object contains nuclear spins of coupled first and second types of nucleus, for example, CHn in which C is a 13 C carbon isotope and H is a 1 H proton. Magnetic resonance signals are generated in the object by RF pulses. Pulse and gradient sequences are generated for providing magnetization transfer from the first nucleus to the second nucleus via first and second channels. A display displays spectra formed from resonance signals processed by a programmed processor via Fourier tranformation of sampled values. A pick up coil is tuned to receive the signals from a corresponding nucleus which is processed by a corresponding channel. The process is volume selective combined with a Hartmann-Hahn transfer sequence.