Structural and Metabolic Insights in Hypertrophic Cardiomyopathy Using LGE and Hyperpolarized 13C Magnetic Resonance Imaging

Motivation: Recent studies suggest that HCM may be fundamentally a metabolic disease. Goal(s): We sought to explore any correlations between metabolism and late gadolinium enhancement in the myocardium that may provide further information on the various metabolic phenotypes of HCM. Approach: We used hyperpolarized 13C-pyruvate MRI to quantify myocardial glycolytic and TCA metabolism and compared this to late gadolinium enhancement (LGE%) from clinical CMR. Results: The findings support the hypothesis that HCM has a significant metabolic component and suggest that HP 13C-MRI could become a valuable tool for characterizing metabolic phenotypes in HCM, potentially aiding in diagnosis, prognosis, and treatment monitoring. Impact: Standard-of-care cardiac magnetic resonance (CMR) provides information on physical form and function, but it does not offer metabolic information on tissue and such information from hyperpolarized 13C MRI could aid in diagnosis and translation of metabolic therapies.