Heart failure with reduced and preserved ejection fraction were associated with 21% and 18% reductions in the pooled cardiac PCr/ATP ratio compared to healthy volunteers (1.96).
Meta-Analysis (n=7,843)
Yes
What are the pooled reference values for the cardiac PCr/ATP ratio measured by 31P-MRS in healthy individuals and patients with various cardiac diseases?
This meta-analysis establishes reference values for the cardiac PCr/ATP ratio, demonstrating significant energetic impairment across various myocardial diseases including HFrEF and HFpEF.
Effect estimate: 21% reduction
Absolute Event Rate: 1.54% vs 1.96%
Abstract Background The cardiac phosphocreatine-to-ATP ratio (PCr/ATP) is the principal non-invasive biomarker of myocardial energetic status, and is measured by phosphorus magnetic resonance spectroscopy (31P-MRS). However, studies of cardiac energetics are typically from single centres with relatively small numbers of patients, leading to unknown generalisability. Methods Here, we use systematic review and meta-analysis of all available studies reporting cardiac PCr/ATP ratios to show pooled reference values across populations (databases searched: Embase, Medline, CENTRAL). We collected data on differing methodological factors to enable adjustment. Results We included 176 studies comprising 7,843 individual participant magnetic resonance examinations between 1987-2025. The pooled PCr/ATP ratio was 1.96 for healthy volunteers (n=2,988), 1.54 for heart failure with reduced ejection fraction (n=575; a 21% reduction), and 1.60 for heart failure with preserved ejection fraction (n=146; an 18% reduction) with further reductions seen across other disease states including valvular disease and diabetes. Methodological factors including field strength, sequence type, and voxel location significantly influenced measurements, though adjustment had minimal effect on pooled estimates. BMI and natriuretic peptides negatively correlated with PCr/ATP, whilst left ventricular systolic function showed positive correlation. Conclusion This comprehensive meta-analysis provides reference PCr/ATP values across cardiac conditions, implicating energetic impairment as a common pathway spanning myocardial diseases of diverse aetiology, and suggests that methodological heterogeneity does not fully account for the observed between-group differences.
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Bray et al. (Tue,) conducted a meta-analysis in Heart failure and other cardiac conditions (n=7,843). Heart failure with reduced ejection fraction (HFrEF) vs. Healthy volunteers was evaluated on Pooled cardiac PCr/ATP ratio (21% reduction). Heart failure with reduced and preserved ejection fraction were associated with 21% and 18% reductions in the pooled cardiac PCr/ATP ratio compared to healthy volunteers (1.96).
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