Could 13C MRI assist clinical decision-making for patients with heart disease?
Could 13C MRI assist clinical decision-making for patients with heart disease?
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DOI：
10.1002/nbm.1718
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发表时间：
2011-10
影响因子：
2.9
通讯作者：
Sherry, A. Dean
中科院分区：
文献类型：
--
作者：
Malloy, Craig R.;Merritt, Matthew E.;Sherry, A. Dean
即使在发展的早期阶段，很明显，对富含 13C 的超极化分子及其代谢产物进行成像为研究心脏生理学和疾病提供了一种新方法。该技术将在人类身上实用，因此我们考虑在临床决策中的作用是否应该激励进一步的发展。可用于治疗冠心病和瓣膜性心脏病的干预措施范围已经很广泛，并且新的选择即将出现。然而，对左心室功能障碍患者的正确治疗可能具有挑战性，因为功能下降的机制可能尚不清楚，并且心室对治疗的反应能力可能难以预测。丙酮酸是作为诊断剂开发的有前途的早期目标，因为它位于心脏生物化学的关键分支点。与乳酸相比，超极化丙酮酸代谢为二氧化碳的相对速率可能被证明是保留线粒体功能的有用指标，因此提供了存活心肌的特定信号。其他分子，包括生理底物以及非生理分子，提供额外的信息。一旦合适的技术出现，临床研究可能会迅速取得进展。直接监测特定代谢途径的能力可能会提高我们选择从干预措施、药物或其他方面受益的患者的能力。
Even at this early stage of development, it is clear that imaging hyperpolarized 13C-enriched molecules and their metabolic products offers a new approach to studying physiology and disease in the heart. The technology will be practical in humans and for this reason we consider whether a role in clinical decision-making should motivate further development. The range of interventions available to treat coronary and valvular heart disease is already extensive, and new options are imminent. Yet the proper management of patients with left ventricular dysfunction can be challenging because the mechanism of reduced function may be unclear and the ability of the ventricle to respond to therapy may be difficult to predict. Pyruvate is a promising early target for development as a diagnostic agent to because it lies at a critical branch point in cardiac biochemistry. The relative rate of metabolism of hyperpolarized pyruvate to CO2 compared to lactate may prove to be a useful indicator of preserved mitochondrial function and therefore provide a specific signal of viable myocardium. Other molecules including physiological substrates as well as nonphysiological molecules provide additional information. Once suitable technology becomes available it is likely that clinical research will progress quickly. The ability to directly monitor specific metabolic pathways may improve our ability to select patients who will benefit from interventions, pharmacologic or otherwise.
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影响因子：
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