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Abnormal cardiac ATP may predict SCD

JCI Insight

Abnormal heart metabolism was associated with a three-fold increased risk of life-threatening arrhythmias in adult individuals participating in a study performed by a research team of Johns Hopkins Medicine (MD, USA) [1]. Furthermore, MRI may be used to identify the high-risk individuals and predict sudden cardiac death (SCD) events. These results indicate that a metabolic approach may be helpful in the treatment or prevention of severe arrhythmias.

The current approach for the prevention of SCD in high-risk individuals is an implanted cardioverter-defibrillator (ICD). However, these devices come with procedural and postprocedural risks, are costly, and, in the majority of cases, never discharge to save a life, according to first author T. Jake Samuel. There is an evident need to improve this situation, preferably through non-invasive approaches.

In the current research, cardiac ATP levels of 46 patients who were scheduled to receive an ICD were assessed via magnetic resonance spectroscopy (MRS) on clinical MRI devices. The average follow-up was approximately 10 years.

Interestingly, those with low cardiac ATP levels, indicating a disturbed metabolism, were 3 times more likely to die of SCD than the patients with normal ATP levels, irrespective of left ventricular ejection fraction. Although larger studies are needed to confirm these findings, the authors commented that the monitoring of cardiac ATP may contribute to the prediction of SCD, and that ATP-targeting agents may be developed in the future to improve cardiac ATP metabolism and reduce the risk of SCD in these patients.

  1. Samuel TJ, et al. Myocardial ATP depletion detected noninvasively predicts sudden cardiac death risk in patients with heart failure. JCI Insight. 2022.

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