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Peder Eric Zufall Larson¹, Shuyu Tang², Xiaoxi Liu¹, Avantika Sinha¹, Nicholas Dwork³, Sanjay Sivalokanathan⁴, Jing Liu¹, Robert Bok¹, Karen G Ordovas⁵, James Slater¹, Jeremy W Gordon¹, and M. Roselle Abraham^1
1Radiology and Biomedical Imaging, University of California - San Francisco, San Francisco, CA, United States, ²HeartVista, Palo Alto, CA, United States, ³University of Colorado Anschutz, Aurora, CO, United States, ⁴University of Pennsylvania, Philadelphia, PA, United States, ⁵University of Washington, Seattle, WA, United States

Keywords: Myocardium, Metabolism

Hyperpolarized (HP) ¹³C-pyruvate MRI is a promising new tool for non-invasive quantification of myocardial glycolytic and Krebs cycle metabolism.  In this study we evaluated whole-heart imaging and metabolism quantification methods in 7 healthy volunteers under a fasted and fed state.  We observed that the ¹³C-pyruvate-to-bicarbonate conversion rate, k_PB, a measure of PDH flux, had the highest, statistically significant correlation with blood glucose levels, with smaller changes in the ¹³C-lactate/pyruvate ratio and ¹³C-pyruvate-to-lactate conversion rate, k_PL.  ¹³C-pyruvate and ¹³C-lactate were detected simultaneously in the RV blood pool, immediately after intravenous injection, reflecting LDH activity in blood.

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Keywords: Cardiomyopathy, Hyperpolarized MR (Non-Gas), Heart Failure, Contrast Agent, Contrast Mechanisms, Metabolism

Using hyperpolarized [1-¹³C]pyruvate MR spectroscopy imaging and cine MRI, we show that targeting cardiometabolic dysregulation with metabolic treatment, such as ketone ester supplementation and/or sodium–glucose cotransporter 2 inhibitor, was effective in improving cardiac function and ameliorating cardiac remodeling in a preclinical model of HFpEF. These results provide a rationale for the assessment of metabolic interventions for patients with HFpEF.

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Michael G Crabb¹, Karl P Kunze^1,2, Camila Munoz¹, Donovan Tripp¹, Anastasia Fotaki¹, Carlos Velasco¹, Radhouene Neji^1,2, Claudia Prieto^1,3, and Rene M Botnar^1,3,4
1School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom, ²MR Research Collaborations, Siemens Healthcare Limited, Camberley, United Kingdom, ³Institute for Biological and Medical Engineering, Pontificia Universidad Catolica de Chile, Santiago, Chile, ⁴School of Engineering, Pontificia Universidad Catolica de Chile, Santiago, Chile

Keywords: Myocardium, Tissue Characterization

Native T1 and T1ρ mapping has shown promising results for the detection of focal and diffuse myocardial fibrosis without the need of contrast agents, whereas T2 mapping enables characterisation of inflammation and edema. However, conventional myocardial maps are acquired in sequential 2D breath-hold scans with limited heart coverage. Here, we propose a novel free-breathing, 3D joint T1/T1ρ/T2 mapping sequence with Dixon encoding to provide whole-heart T1, T1ρ and T2 maps and co-registered water/fat volumes with isotropic spatial resolution for comprehensive contrast-agent free myocardial tissue characterization. Preliminary results demonstrate good agreement with reference values in phantoms and promising results in-vivo.

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Dongyue Si¹, Rui Guo², Daniel A. Herzka³, and Haiyan Ding^1
1Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China, ²School of Medical Technology, Beijing Institute of Technology, Beijing, China, ³Department of Radiology, Case Western Reserve University, Cleveland, OH, United States

Keywords: Myocardium, Tissue Characterization

MR parametric mapping including T₁ and T₂ enabled quantitative evaluation of changes of myocardium. We previously proposed a time-efficient technique for 3D free-breathing simultaneous T₁ and T₂ mapping based on multi-parametric SAturation recovery and Variable flip Angle (mSAVA). This study evaluated the accuracy, precision, and reproducibility of mSAVA in comparison with conventional 2D sequences. mSAVA achieved good accuracy, between that of MOLLI and SASHA, and better precision and reproducibility than SASHA for T₁ measurements. T₂ measured by mSAVA had better precision and reproducibility than both GraSE and bSSFP T₂. mSAVA offers a promising option for myocardial tissue characterization.

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Kevin Moulin^1,2, Luigi E. Perotti³, Magalie Viallon^1,2, and Pierre Croisille^1,2
1University of Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, INSERM U1206, CREATIS, F-42023, Saint-Etienne, France, ²Department of Radiology, University Hospital Saint-Etienne, Saint-Etienne, France, ³Department of Mechanical and Aerospace Engineering, University of Central Florida, Orlando, FL, United States

Keywords: Myocardium, Cardiovascular, Cardiac Function, cDTI, DENSE, Feature Tracking, cardiac microstructure

Myofiber strain (MS) is a promising biomarker of cardiac function, but it requires the combination of cDTI and of a 3D cardiac displacement field. Displacement fields can be measured using DENSE imaging, but with low spatial resolution and limited spatial coverage. Feature tracking (FT) allows the estimation of the displacement directly from cine imaging. In this study, myofiber strains estimated using DENSE and FT were  compared on thirty healthy volunteers. The magnitude of myofiber strain calculated with DENSE was higher than with FT (MS_DENSE=-0.15[-0.16;-0.14] vs MS_FT=-0.11[-0.14;-0.06], p<0.001) but no correlation was found between MSD_ENSE and MS_FT (r=0.14 p=0.47).

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Jiahao Li^1,2, Pablo Villar-Calle³, Hannah Agoglia³, Nicole Liberman³, Thanh D. Nguyen², Yi Wang^1,2, Jiwon Kim³, Jonathan W. Weinsaft³, and Pascal Spincemaille^2
1Biomedical Engineering, Cornell University, Ithaca, NY, United States, ²Radiology, Weill Cornell Medicine, New York, NY, United States, ³Medicine, Weill Cornell Medicine, New York, NY, United States

Keywords: Heart, Oxygenation

A breath-holding non-cardiac gated 3D stack-of-spiral data acquisition scheme was developed to continuously sample the data for cardiac quantitative susceptibility mapping. Compared to the previously proposed navigator-based prospective Cartesian acquisition, the accelerated spiral sequence can be done within 20 seconds breath-holds, leading to over a 20-fold reduction in scan time. The spiral QSM as well as the navigator QSM were performed on cohorts of healthy volunteers and COVID-19 survivors, showing well aligned quantification results on the differential blood oxygenation between the right and left heart.

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Qinfang Miao^1,2, Zhenfeng Lv^1,2, Sha Hua³, Zhongqi Zhang⁴, Jian Xu⁴, Peng Hu^1,2, and Haikun Qi^1,2
1School of Biomedical Engineering, ShanghaiTech University, Shanghai, China, ²Shanghai Clinical Research and Trial Center, Shanghai, China, ³Department of Cardiovascular Medicine, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China, ⁴UIH America, Inc., Houston, TX, United States

Keywords: Myocardium, Cardiomyopathy

Uremic cardiomyopathy is the adverse cardiac remodeling that commonly occurs in patients with chronic kidney disease. Previous studies have indicated increased intramyocardial fluid and myocardial fibrosis in uremic patients, which makes native myocardial T2 and T1ρ mapping ideal imaging biomarkers to characterize these changes. Therefore, we propose a free-breathing simultaneous T2 and T1ρ mapping technique to provide co-registered T2 and T1ρ maps. The proposed technique was firstly evaluated in phantoms and ten healthy subjects, which achieved similar performance to the conventional separate T2 and T1ρ mapping methods. The preliminary validation in four hemodialysis patients showed promising results.

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Damian Tyler¹, Moritz Hundertmark¹, Adrienne Siu¹, Violet Matthews², Andrew Lewis¹, James Grist^1,2, Jai Patel³, Paul Chamberlin³, Rizwan Sarwar¹, Arash Yavari^1,3, Hakim-Moulay Dehbi⁴, Michael Frenneaux⁵, Ladislav Valkovič^1,6, Jack Miller^1,7, Stefan Neubauer¹, and Oliver Rider^1
1University of Oxford, Oxford, United Kingdom, ²Oxford University Hospitals NHS Foundations Trust, Oxford, United Kingdom, ³Imbria Pharmaceuticals, Boston, MA, United States, ⁴University College London, London, United Kingdom, ⁵Hamad Medical Corporation, Doha, Qatar, ⁶Slovak Academy of Sciences, Bratislava, Slovakia, ⁷Aarhus University, Aarhus, Denmark

Keywords: Heart, Diabetes, Multi-nuclear Spectroscopy

Patients with Type 2 Diabetes (T2D) are at a significantly increased risk of heart failure (HF) with the development of HF driven by energetic, metabolic, structural, and functional cardiac changes. In this study we have used a multi-nuclear MRI/MRS approach to demonstrate that the novel metabolic modulator, ninerafaxstat, can significantly improve myocardial energetics, cardiac steatosis and diastolic function in patients with T2D and obesity. In addition, using cardiac hyperpolarized [1-¹³C]pyruvate MRS, we have identified a potential signal for increased pyruvate dehydrogenase flux upon treatment with ninerafaxstat.

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Wen-yi Jiang¹, Weibo Chen², Yan Zhou¹, Lei Zhao³, and Lian-Ming Wu^1
1Renji Hospital affiliated to Shanghai Jiao Tong University, Shanghai, China, ²Philips Healthcare, Shanghai, China, ³Beijing Anzhen Hospital affiliated to Capital Medical University, Beijing, China

Keywords: Cardiomyopathy, Heart

Trabecular complexity of left and right ventricles can be quantified as fractal dimension (FD), a number between 1 to 2, by fractal analysis on short axis cine images of cardiovascular magnetic resonance. We found that biventricular FDs provide significant prognostic value for sudden cardiac death and composited adverse events including rehospitalization due to heart failure in patients with hypertrophic cardiomyopathy (HCM). LV maximal apical FD and RV global FD are independent prognostic factors in HCM. In addition, they provide incremental prognostic value to the conventional predictors including European Society of Cardiology predictors and late gadolinium enhancement percentage.

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Keywords: Flow, Velocity & Flow

Atrial fibrillation (AF) leads to detrimental changes in the left atrial (LA) and left atrial appendage’s (LAA) hemodynamics and volumes. When indicated, AF ablation is used to reduce AF burden. We recruited 17 post-ablation patients, 10 of whom had no documented AF recurrences. 4D flow MRI was acquired, immediately before and 6-12months after ablation, and quantified for LA and LAA stasis, volume, and peak velocities. Our findings support the notion that restoration of sinus rhythm corrects the deleterious changes of AF.