Nuclear magnetic resonance (NMR) criteria of early cardiac rejection are similar to those seen in myocardial ischemia, that is, a reduction of high energy phosphatases (Pc; ATP) and an increase of inorganic phosphates (Pi). Our aim was to assess in vivo changes of phosphorous spectroscopy (31P) induced by cardiac rejection and myocardial ischemia in the same animal. Heterotopic heart isografts (n = 5) and untreated allografts (n = 5) were examined at seven days on a two tesla wide-bore magnet with a surface coil. Subtotal global ischemia was produced for sequential NMR measurements, followed by heart excision for histological rejection grading (Billingham). Results 1. Isograft served as controls and showed normal energy-rich phosphate compounds and pH. 2. Rejecting (moderate to severe) allografts showed a decrease of Pc/Pi and beta-ATP/Pi ratio compared with isografts. However no significant pH drop could be detected. 3. Induced ischemia was confirmed by marked ECG-ST elevation and showed a significant early global myocardial acidosis (pH less than 6.9) particularly in severe prolonged ischemia (p less than 0.05). 4. Using 31P NMR techniques, ischemically induced changes were similar in isografts and allografts with a trend towards a more pronounced extent in the latter groups. In conclusion, magnetic resonance spectroscopy (31P and pH) allows in vivo differentiation between cardiac rejection and acute myocardial ischemia.

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