Background: Hyperpolarized [1-13C]pyruvate cardiovascular magnetic resonance imaging (HP [1-13C]pyruvate CMR) visualizes key steps in myocardial metabolism. The present study aimed to examine patients with heart failure (HF) using HP [1-13C]pyruvate CMR.
Methods: A cross-sectional study of patients with HF and healthy controls using HP [1-13C]pyruvate CMR. Metabolic imaging was obtained using a cardiac-gated spectral-spatial excitation with spiral read-out acquisition. The metabolite signal was analyzed for lactate, bicarbonate, and the alanine signal. Metabolite signal was normalized to the total carbon signal (TC). At the 1-year follow-up, echocardiography was performed in all patients and HP [1-13C]pyruvate MRI in two patients.
Results: We included six patients with ischemic heart disease (IHD), six with dilated cardiomyopathy, and six healthy controls. In patients, left ventricular ejection fraction (LVEF) correlated with lactate/bicarbonate (r = -0.6, p = 0.03) and lactate/TC (r = -0.7, p = 0.01). In patients with LVEF <30%, lactate/TC was increased (p = 0.01) and bicarbonate/TC reduced (p = 0.03). Circumferential strain correlated with metabolite ratios: lactate/bicarbonate, r = 0.87 (p = 0.0002); lactate/TC, r = 0.85 (p = 0.0005); bicarbonate/TC, r = -0.82 (p = 0.001). In patients with IHD, a strong correlation was found between baseline metabolite ratios and the change in LVEF at follow-up: lactate/bicarbonate (p = 0.001), lactate/TC (p = 0.011), and bicarbonate/TC (p = 0.012).
Conclusions: This study highlighted the ability of HP [1-13C]pyruvate CMR to detect changes in metabolism in HF. HP [1-13C]pyruvate CMR has the potential for metabolic phenotyping of patients with HF and for predicting treatment response.
Trial registration: EUDRACT, 2018-003533-15. Registered December 4, 2018, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2018-003533-15.
Keywords: Cardiac metabolism; Heart failure; Hyperpolarized [1-(13)C]pyruvate magnetic resonance imaging; Metabolic imaging.
Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.