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Magnetic resonance imaging of cardiac metabolism in heart failure: how far have we come?

Journal

EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING
Volume 23, Issue 10, Pages 1277-1289

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/ehjci/jeac121

Keywords

cardiac metabolism; heart failure; magnetic resonance imaging; magnetic resonance spectroscopy; hyperpolarized MRS

Funding

  1. National Institute of Health [R01 HL151704, R01 HL159010, R01 HL135242, 1R21JM137227]

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As one of the highest energy consuming organs in the body, the heart relies on various fuel sources to generate ATP for its continuous work. Magnetic resonance imaging (MRI) plays a crucial role in understanding the metabolic changes in the failing heart, and noninvasive quantification of metabolic changes has potential clinical applications. Novel MRI techniques, such as magnetic resonance spectroscopy (MRS), hyperpolarized MRS, and chemical exchange saturation transfer, provide detailed investigation of cardiac metabolism in heart failure.
As one of the highest energy consumer organs in the body, the heart requires tremendous amount of adenosine triphosphate (ATP) to maintain its continuous mechanical work. Fatty acids, glucose, and ketone bodies are the primary fuel source of the heart to generate ATP with perturbations in ATP generation possibly leading to contractile dysfunction. Cardiac metabolic imaging with magnetic resonance imaging (MRI) plays a crucial role in understanding the dynamic metabolic changes occurring in the failing heart, where the cardiac metabolism is deranged. Also, targeting and quantifying metabolic changes in vivo noninvasively is a promising approach to facilitate diagnosis, determine prognosis, and evaluate therapeutic response. Here, we summarize novel MRI techniques used for detailed investigation of cardiac metabolism in heart failure including magnetic resonance spectroscopy (MRS), hyperpolarized MRS, and chemical exchange saturation transfer based on evidence from preclinical and clinical studies and to discuss the potential clinical application in heart failure.

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