title: MRS: a noninvasive window into cardiac metabolism.
abstract: A well-functioning heart requires a constant supply of a balanced mixture of nutrients to be used for the production of adequate amounts of adenosine triphosphate, which is the main energy source for most cellular functions. Defects in cardiac energy metabolism are linked to several myocardial disorders. MRS can be used to study in vivo changes in cardiac metabolism noninvasively. MR techniques allow repeated measurements, so that disease progression and the response to treatment or to a lifestyle intervention can be monitored. It has also been shown that MRS can predict clinical heart failure and death. This article focuses on in vivo MRS to assess cardiac metabolism in humans and experimental animals, as experimental animals are often used to investigate the mechanisms underlying the development of metabolic diseases. Various MR techniques, such as cardiac (31) P-MRS, (1) H-MRS, hyperpolarized (13) C-MRS and Dixon MRI, are described. A short overview of current and emerging applications is given. Cardiac MRS is a promising technique for the investigation of the relationship between cardiac metabolism and cardiac disease. However, further optimization of scan time and signal-to-noise ratio is required before broad clinical application. In this respect, the ongoing development of advanced shimming algorithms, radiofrequency pulses, pulse sequences, (multichannel) detection coils, the use of hyperpolarized nuclei and scanning at higher magnetic field strengths offer future perspective for clinical applications of MRS.
authors.affiliation: Maastricht University Medical Center, Human Biology, Maastricht, the Netherlands.|Maastricht University Medical Center, Radiology, Maastricht, the Netherlands.|Maastricht University Medical Center, NUTRIM - School for Nutrition, Toxicology and Metabolism, Maastricht, the Netherlands.
authors.forename: Petronella A
authors.initials: PA
authors.lastname: van Ewijk
authors.affiliation: Maastricht University Medical Center, Human Biology, Maastricht, the Netherlands.|Maastricht University Medical Center, Radiology, Maastricht, the Netherlands.|Maastricht University Medical Center, NUTRIM - School for Nutrition, Toxicology and Metabolism, Maastricht, the Netherlands.
authors.forename: Vera B
authors.initials: VB
authors.lastname: Schrauwen-Hinderling
authors.affiliation: Maastricht University Medical Center, Cardiology, Maastricht, the Netherlands.
authors.forename: Sebastiaan C A M
authors.initials: SC
authors.lastname: Bekkers
authors.affiliation: Maastricht University Medical Center, Molecular Genetics, Maastricht, the Netherlands.|Maastricht University Medical Center, CARIM - Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
authors.forename: Jan F C
authors.initials: JF
authors.lastname: Glatz
authors.affiliation: Maastricht University Medical Center, Radiology, Maastricht, the Netherlands.
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Wildberger
authors.affiliation: Maastricht University Medical Center, Radiology, Maastricht, the Netherlands.|Maastricht University Medical Center, NUTRIM - School for Nutrition, Toxicology and Metabolism, Maastricht, the Netherlands.|Maastricht University Medical Center, CARIM - Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands.
authors.forename: M Eline
authors.identifier: http://orcid.org/0000-0001-7562-5724
authors.initials: ME
authors.lastname: Kooi
mesh_terms: D000818:Animals; D015415:Biomarkers / Q000378:metabolism; D006331:Heart Diseases / Q000175:diagnosis / Q000378:metabolism*; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008659:Metabolic Diseases / Q000175:diagnosis / Q000378:metabolism*; D009206:Myocardium / Q000378:metabolism*
chemical_list: D015415:Biomarkers
keywords: Dixon MRI; MRS; animal; cardiac metabolism; human