{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T20:17:11Z","timestamp":1769113031153,"version":"3.49.0"},"reference-count":50,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2014,8,15]]},"abstract":"\n Background<\/jats:title>\n \n Left ventricular (\n LV<\/jats:styled-content>\n ) energy supply\u2010demand imbalance is postulated to cause \u201cenergy starvation\u201d and contribute to heart failure (\n HF<\/jats:styled-content>\n ) in nonischemic dilated cardiomyopathy (\n NIDCM<\/jats:styled-content>\n ). Using cardiac magnetic resonance (\n CMR<\/jats:styled-content>\n ) and [\n 11<\/jats:sup>\n C] acetate positron emission tomography (\n PET<\/jats:styled-content>\n ), we evaluated\n LV<\/jats:styled-content>\n perfusion and oxidative metabolism in\n NIDCM<\/jats:styled-content>\n and the effects of spironolactone on\n LV<\/jats:styled-content>\n supply\u2010demand relations.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Twelve patients with\n NIDCM<\/jats:styled-content>\n underwent\n CMR<\/jats:styled-content>\n and\n PET<\/jats:styled-content>\n at baseline and after \u22656\u00a0months of spironolactone therapy added to a standard\n HF<\/jats:styled-content>\n regimen. The myocardial perfusion reserve index (\n MPRI<\/jats:styled-content>\n ) was calculated after gadolinium injection during adenosine, as compared to rest. The monoexponential clearance rate of [\n 11<\/jats:sup>\n C] acetate (k\n mono<\/jats:sub>\n ) was used to calculate the work metabolic index (\n WMI<\/jats:styled-content>\n ), an index of\n LV<\/jats:styled-content>\n mechanical efficiency, and k\n mono<\/jats:sub>\n \/\n RPP<\/jats:styled-content>\n (rate\u2010pressure product), an index of energy supply\/demand. At baseline, the subendocardium was hypoperfused versus the subepicardium (median\n MPRI,<\/jats:styled-content>\n 1.63 vs. 1.80;\n P<\/jats:italic>\n <0.001), but improved to 1.80 (\n P<\/jats:italic>\n <0.001) after spironolactone. The\n WMI<\/jats:styled-content>\n increased (\n P<\/jats:italic>\n =0.001), as did k\n mono<\/jats:sub>\n \/\n RPP<\/jats:styled-content>\n (\n P<\/jats:italic>\n =0.003). These improvements were associated with reverse remodeling, increased\n LV ejection fraction<\/jats:styled-content>\n , and decreases in\n LV<\/jats:styled-content>\n mass and systolic wall stress (all\n P<\/jats:italic>\n <0.002).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n NIDCM<\/jats:styled-content>\n is associated with subendocardial hypoperfusion and impaired myocardial oxidative metabolism, consistent with energy starvation. Antifailure therapy improves parameters of energy starvation and is associated with augmented\n LV<\/jats:styled-content>\n performance.\n <\/jats:p>\n <\/jats:sec>\n \n Clinical Trial Registration<\/jats:title>\n \n URL:\n http:\/\/www.clinicaltrials.gov\/<\/jats:ext-link>\n Unique identifier: ID NCT00574119.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.114.000883","type":"journal-article","created":{"date-parts":[[2014,8,28]],"date-time":"2014-08-28T06:36:06Z","timestamp":1409207766000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Antifailure Therapy Including Spironolactone Improves Left Ventricular Energy Supply\u2010Demand Relations in Nonischemic Dilated Cardiomyopathy"],"prefix":"10.1161","volume":"3","author":[{"given":"Susan P.","family":"Bell","sequence":"first","affiliation":[{"name":"Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, VA Tennessee Valley Healthcare System, Nashville, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas W.","family":"Adkisson","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, VA Tennessee Valley Healthcare System, Nashville, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark A.","family":"Lawson","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, VA Tennessee Valley Healthcare System, Nashville, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Henry","family":"Ooi","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, VA Tennessee Valley Healthcare System, Nashville, TN"},{"name":"Cardiology Section, VA Tennessee Valley Healthcare System, Nashville, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas B.","family":"Sawyer","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, VA Tennessee Valley Healthcare System, Nashville, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marvin W.","family":"Kronenberg","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, VA Tennessee Valley Healthcare System, Nashville, TN"},{"name":"Cardiology Section, VA Tennessee Valley Healthcare System, Nashville, TN"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199001113220206"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.RES.0000137170.41939.d9"},{"key":"e_1_3_5_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.105.584102"},{"key":"e_1_3_5_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(89)90386-X"},{"key":"e_1_3_5_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2008.05.064"},{"key":"e_1_3_5_7_2","doi-asserted-by":"publisher","DOI":"10.1023\/A:1006876031121"},{"key":"e_1_3_5_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)02160-5"},{"key":"e_1_3_5_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra063052"},{"key":"e_1_3_5_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/hc0202.102119"},{"key":"e_1_3_5_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.92.4.796"},{"key":"e_1_3_5_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(02)02772-9"},{"key":"e_1_3_5_13_2","doi-asserted-by":"publisher","DOI":"10.1002\/mrm.1910290410"},{"key":"e_1_3_5_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2012.01.016"},{"key":"e_1_3_5_15_2","doi-asserted-by":"publisher","DOI":"10.3109\/10976640009146567"},{"key":"e_1_3_5_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa012369"},{"key":"e_1_3_5_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(93)90548-F"},{"key":"e_1_3_5_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.80.4.863"},{"key":"e_1_3_5_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.81.5.1594"},{"key":"e_1_3_5_20_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.76.3.687"},{"key":"e_1_3_5_21_2","first-page":"187","article-title":"Validity of estimates of myocardial oxidative metabolism with carbon\u201011 acetate and positron emission tomography despite altered patterns of substrate utilization","volume":"30","author":"Brown MA","year":"1989","unstructured":"Brown MA, Myears DW, Bergmann SR. 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