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

Eur Heart J Cardiovasc Imaging. 2022 Sep 10;23(10):1277-1289. doi: 10.1093/ehjci/jeac121.


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.

Keywords: cardiac metabolism • heart failure • magnetic resonance imaging • magnetic resonance spectroscopy • hyperpolarized MRS.

MeSH terms

  • Adenosine Triphosphate / metabolism
  • Energy Metabolism
  • Fatty Acids / metabolism
  • Heart Failure* / diagnosis
  • Humans
  • Magnetic Resonance Imaging
  • Magnetic Resonance Spectroscopy / methods
  • Myocardium / metabolism


  • Fatty Acids
  • Adenosine Triphosphate