Pressure overload in aortic stenosis (AS) encompasses both structural and metabolic remodeling and increases the risk of decompensation into heart failure. A major component of metabolic derangement in AS is abnormal cardiac substrate use, with down-regulation of fatty acid oxidation, increased reliance on glucose metabolism, and subsequent myocardial lipid accumulation. These changes are associated with energetic and functional cardiac impairment in AS and can be assessed with the use of cardiac magnetic resonance spectroscopy (MRS). Proton MRS allows the assessment of myocardial triglyceride content and creatine concentration. Phosphorous MRS allows noninvasive in vivo quantification of the phosphocreatine-to-adenosine triphosphate ratio, a measure of cardiac energy status that is reduced in patients with severe AS. This review summarizes the changes to cardiac substrate and high-energy phosphorous metabolism and how they affect cardiac function in AS. The authors focus on the role of MRS to assess these metabolic changes, and potentially guide future (cellular) metabolic therapy in AS.

主动脉瓣狭窄 (AS) 的压力超负荷包括结构和代谢重塑，并增加失代偿成心力衰竭的风险。AS 中代谢紊乱的一个主要组成部分是异常的心脏底物使用，伴随着脂肪酸氧化的下调、对葡萄糖代谢的依赖增加以及随后的心肌脂质积累。这些变化与 AS 中的能量和功能性心脏损伤有关，可以使用心脏磁共振波谱 (MRS) 进行评估。质子 MRS 可以评估心肌甘油三酯含量和肌酸浓度。磷 MRS 允许对磷酸肌酸与三磷酸腺苷比率进行无创体内量化，这是一种衡量严重 AS 患者心脏能量状态降低的指标。这篇综述总结了心脏底物和高能磷代谢的变化以及它们如何影响 AS 患者的心脏功能。作者重点关注 MRS 在评估这些代谢变化中的作用，并可能指导未来 AS 的（细胞）代谢治疗。