Metabolic and structural adaptations after acute myocardial infarction as assessed with multimodal CMR

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Acute myocardial infarction (AMI) and subsequent ischemic heart disease (IHD) are epidemiologically and economically the most significant diseases in western societies. Although reperfusion therapies have significantly improved patient outcome over the past years, reduction of ischemia-associated remodelling and subsequent prevention of chronic heart failure (CHF) remains challenging. The resulting dynamic adaptations after AMI affect the subsequent healing phase by a complex interplay of cells, structural and metabolic alterations. Those metabolic adaptations are characterized by a “metabolic switch” in myocardial energy supply from predominantly aerobic fatty acid (FA) oxidation to anaerobic glycolysis. Once energy supply cannot be sustained, the impaired energy reserve leads to functional and structural adaptations. Since quantity and quality of structural alterations in the acute phase after AMI are predictors of myocardial adaptation, there is growing evidence of an additional contribution of local myocardial metabolism. Existing non-invasive techniques such as single-photon emission computed tomography (SPECT) and positron emission tomography (PET) exhibit good sensitivity in quantification of cardiac metabolism, but they are failing in adequate loco-regional visualization, lack specificity and use ionising radiation. Cardiovascular Magnetic Resonance (CMR) has successfully been established to characterize myocardial substrate selection (13C- hyperpolarization), energy supply (creatine quantification by chemical exchange saturation transfer (CrEST)) as well as structural tissue adaptation on a microscopic level (diffusion tensor imaging (DTI)). We hypothesize, that metabolic imaging with CMR provides additive information on future cardiac adaptation after AMI for a personalized disease management. Based on this, we aim to combine those novel techniques in a multimodal imaging approach to (I) monitor structural and metabolic changes in the acute phase after AMI and (II) to investigate the impact of structural and metabolic alterations on long-term myocardial remodelling.