It is hypothesized that chemical energy supply is insufficient to fuel normal mechanical pump function in heart failure (HF). To test whether reduced function correlates with reduced energy supply, we used magnetic resonance spectroscopy and imaging to measure adenosine triphosphate (ATP) synthesis via the creatine kinase reaction–the heart’s primary reserve–and cardiac mechanical stroke work in 14 healthy subjects and 27 patients with mild-to-moderate HF. We found significantly reduced cardiac creatine kinase flux that correlated with peak and average stroke work rates and with mechanical efficiency. These first noninvasive findings are consistent with the energy deprivation hypothesis of HF.
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