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For: Timm KN, Apps A, Miller JJ, Ball V, Chong C, Dodd MS, Tyler DJ. Assessing the optimal preparation strategy to minimize the variability of cardiac pyruvate dehydrogenase flux measurements with hyperpolarized MRS. NMR Biomed 2018;31:e3992. [PMID: 30040147 PMCID: PMC6175301 DOI: 10.1002/nbm.3992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 05/11/2023]

For:	Timm KN, Apps A, Miller JJ, Ball V, Chong C, Dodd MS, Tyler DJ. Assessing the optimal preparation strategy to minimize the variability of cardiac pyruvate dehydrogenase flux measurements with hyperpolarized MRS. NMR Biomed 2018;31:e3992. [PMID: 30040147 PMCID: PMC6175301 DOI: 10.1002/nbm.3992] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 05/11/2023]

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Cited by Other Article(s)

Larson PEZ, Tang S, Liu X, Sinha A, Dwork N, Sivalokanathan S, Liu J, Bok R, Ordovas KG, Slater J, Gordon JW, Abraham MR. Regional quantification of cardiac metabolism with hyperpolarized [1-¹³C]-pyruvate CMR evaluated in an oral glucose challenge. J Cardiovasc Magn Reson 2023;25:77. [PMID: 38093285 PMCID: PMC10720165 DOI: 10.1186/s12968-023-00972-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 10/19/2023] [Indexed: 12/17/2023] Open

Abstract

BACKGROUND

The heart has metabolic flexibility, which is influenced by fed/fasting states, and pathologies such as myocardial ischemia and hypertrophic cardiomyopathy (HCM). Hyperpolarized (HP) 13C-pyruvate MRI is a promising new tool for non-invasive quantification of myocardial glycolytic and Krebs cycle flux. However, human studies of HP 13C-MRI have yet to demonstrate regional quantification of metabolism, which is important in regional ischemia and HCM patients with asymmetric septal/apical hypertrophy.

METHODS

We developed and applied methods for whole-heart imaging of 13C-pyruvate, 13C-lactate and 13C-bicarbonate, following intravenous administration of [1-13C]-pyruvate. The image acquisition used an autonomous scanning method including bolus tracking, real-time magnetic field calibrations and metabolite-specific imaging. For quantification of metabolism, we evaluated 13C metabolite images, ratio metrics, and pharmacokinetic modeling to provide measurements of myocardial lactate dehydrogenase (LDH) and pyruvate dehydrogenase (PDH) mediated metabolic conversion in 5 healthy volunteers (fasting & 30 min following oral glucose load).

RESULTS

We demonstrate whole heart coverage for dynamic measurement of pyruvate-to-lactate conversion via LDH and pyruvate-to-bicarbonate conversion via PDH at a resolution of 6 × 6 × 21 mm3 (13C-pyruvate) and 12 × 12 × 21 mm3 (13C-lactate, 13C-bicarbonate). 13C-pyruvate and 13C-lactate were detected simultaneously in the RV blood pool, immediately after intravenous injection, reflecting LDH activity in blood. In healthy volunteers, myocardial 13C-pyruvate-SNR, 13C-lactate-SNR, 13C-bicarbonate-SNR, 13C-lactate/pyruvate ratio, 13C-pyruvate-to-lactate conversion rate, kPL, and 13C-pyruvate-to-bicarbonate conversion rate, kPB, all had statistically significant increases following oral glucose challenge. kPB, reflecting PDH activity and pyruvate entering the Krebs Cycle, had the highest correlation with blood glucose levels and was statistically significant.

CONCLUSIONS

We demonstrate first-in-human regional quantifications of cardiac metabolism by HP 13C-pyruvate MRI that aims to reflect LDH and PDH activity.

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Affiliation(s)

Peder E Z Larson Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA. UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, CA, USA.
Shuyu Tang Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, CA, USA Vista.ai, Palo Alto, CA, USA
Xiaoxi Liu Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
Avantika Sinha Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
Nicholas Dwork Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA Departments of Bioinformatics and Radiology, University of Colorado School of Medicine, Denver, CO, USA
Sanjay Sivalokanathan Division of Internal Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
Jing Liu Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
Robert Bok Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
Karen G Ordovas Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA Department of Radiology, University of Washington, Seattle, WA, USA
James Slater Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
Jeremy W Gordon Department of Radiology and Biomedical Imaging, University of CA-San Francisco, 1700 4th Street, Byers Hall Room 102C, San Francisco, CA, 94143, USA
M Roselle Abraham Cardiology Division, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA

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Larson PEZ, Tang S, Liu X, Sinha A, Dwork N, Sivalokanathan S, Liu J, Bok R, Ordovas KG, Slater J, Gordon JW, Abraham MR. Regional quantification of cardiac metabolism with hyperpolarized [1-¹³C]-pyruvate MRI evaluated in an oral glucose challenge. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.16.23297052. [PMID: 37904936 PMCID: PMC10615005 DOI: 10.1101/2023.10.16.23297052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]

Abstract

Background

Methods

Results

We demonstrate whole heart coverage for dynamic measurement of pyruvate-to-lactate conversion via LDH and pyruvate-to-bicarbonate conversion via PDH at a resolution of 6×6×21 mm3 (13C-pyruvate) and 12×12×21 mm3 (13C-lactate, 13C-bicarbonate) . 13C-pyruvate and 13C-lactate were detected simultaneously in the RV blood pool, immediately after intravenous injection, reflecting LDH activity in blood. In healthy volunteers, myocardial 13C-pyruvate-SNR, 13C-lactate-SNR, 13C-bicarbonate-SNR, 13C-lactate/pyruvate ratio, 13C-pyruvate-to-lactate conversion rate, kPL, and 13C-pyruvate-to-bicarbonate conversion rate, kPB, all had statistically significant increases following oral glucose challenge. kPB, reflecting PDH activity and pyruvate entering the Krebs Cycle, had the highest correlation with blood glucose levels and was statistically significant.

Conclusions

We demonstrate first-in-human regional quantifications of cardiac metabolism by HP 13C-pyruvate MRI that aims to reflect LDH and PDH activity.

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Affiliation(s)

Peder E Z Larson Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California, USA
Shuyu Tang Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA UC Berkeley-UCSF Graduate Program in Bioengineering, University of California, Berkeley and University of California, San Francisco, California, USA Vista.ai, Palo Alto, CA, USA
Xiaoxi Liu Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
Avantika Sinha Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
Nicholas Dwork Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA Departments of Bioinformatics and Radiology, University of Colorado School of Medicine, Denver, CO, USA
Sanjay Sivalokanathan Department of Medicine - Division of Internal Medicine, University of Pennsylvania, Philadelphia, PA, USA
Jing Liu Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
Robert Bok Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
Karen G Ordovas Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
James Slater Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
Jeremy W Gordon Department of Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, California, USA
M Roselle Abraham Department of Medicine - Cardiology Division, University of California - San Francisco, San Francisco, California, USA

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Joergensen SH, Hansen ESS, Bøgh N, Bertelsen LB, Staehr PB, Schulte RF, Malloy C, Wiggers H, Laustsen C. Detection of increased pyruvate dehydrogenase flux in the human heart during adenosine stress test using hyperpolarized [1-¹³C]pyruvate cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2022;24:34. [PMID: 35658896 PMCID: PMC9169396 DOI: 10.1186/s12968-022-00860-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open

Abstract

BACKGROUND

Hyperpolarized (HP) [1-13C]pyruvate cardiovascular magnetic resonance (CMR) imaging can visualize the uptake and intracellular conversion of [1-13C]pyruvate to either [1-13C]lactate or 13C-bicarbonate depending on the prevailing metabolic state. The aim of the present study was to combine an adenosine stress test with HP [1-13C]pyruvate CMR to detect cardiac metabolism in the healthy human heart at rest and during moderate stress.

METHODS

A prospective descriptive study was performed between October 2019 and August 2020. Healthy human subjects underwent cine CMR and HP [1-13C]pyruvate CMR at rest and during adenosine stress. HP [1-13C]pyruvate CMR images were acquired at the mid-left-ventricle (LV) level. Semi-quantitative assessment of first-pass myocardial [1-13C]pyruvate perfusion and metabolism were assessed. Paired t-tests were used to compare mean values at rest and during stress.

RESULTS

Six healthy subjects (two female), age 29 ± 7 years were studied and no adverse reactions occurred. Myocardial [1-13C]pyruvate perfusion was significantly increased during stress with a reduction in time-to-peak from 6.2 ± 2.8 to 2.7 ± 1.3 s, p = 0.02. This higher perfusion was accompanied by an overall increased myocardial uptake and metabolism. The conversion rate constant (kPL) for lactate increased from 11 ± 9 *10-3 to 20 ± 10 * 10-3 s-1, p = 0.04. The pyruvate oxidation rate (kPB) increased from 4 ± 4 *10-3 to 12 ± 7 *10-3 s-1, p = 0.008. This increase in carbohydrate metabolism was positively correlated with heart rate (R2 = 0.44, p = 0.02).

CONCLUSIONS

Adenosine stress testing combined with HP [1-13C]pyruvate CMR is feasible and well-tolerated in healthy subjects. We observed an increased pyruvate oxidation during cardiac stress. The present study is an important step in the translation of HP [1-13C]pyruvate CMR into clinical cardiac imaging. Trial registration EUDRACT, 2018-003533-15. Registered 4th of December 2018, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2018-003533-15.

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