Hyperpolarized [13C]Bicarbonate Selective CINE: Correlation of Myocardial Metabolism with Rate-Pressure Product During Cardiac Stress

Motivation: Accurate assessment of myocardial metabolism during cardiac stress is vital for understanding cardiac function and disease, but existing methods lack real-time metabolic resolution and specificity. Goal(s): To develop and evaluate BicarbCINE, a hyperpolarized [13C]bicarbonate-selective CINE imaging method, to correlate myocardial metabolism with cardiac work during stress. Approach: We implemented BicarbCINE to simultaneously image [13C]bicarbonate and off-resonance [1-13C]pyruvate in porcine hearts under rest and pharmacological stress. Bicarbonate/pyruvate ratios(BP ratios) were analyzed against changes in Rate-Pressure-Product(RPP). Results: BicarbCINE achieved high temporal resolution, showing significant increases in BP ratios with stress and a strong correlation between systolic BP ratio and RPP change. Impact: BicarbCINE provides high temporal resolution and specificity in cardiac metabolic imaging, significantly advancing the assessment of myocardial metabolism. This technique could enhance diagnostic accuracy for cardiac diseases, improve patient management, and guide treatment decisions, especially in stress-induced cardiac dysfunction.