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This study aimed to investigate real-time early detection of metabolic alteration in a rat model with acute myocardial ischemia-reperfusion (AMI/R) injury and myocardial necrosis, as well as its correlation with intracellular pH level using  in vivo  hyperpolarized [1- 13 C] pyruvate magnetic resonance spectroscopy (MRS). Hyperpolarized  13 C MRS was performed on the myocardium of 8 sham-operated control rats and 8 rats with AMI/R injury, and 8 sham-operated control rats and 8 rats with AMI-induced necrosis. Also, the correlations of levels of [1- 13 C] metabolites with pH were analyzed by Spearman’s correlation test. The AMI/R and necrosis groups showed significantly higher ratios of [1- 13 C] lactate (Lac)/bicarbonate (Bicar) and [1- 13 C] Lac/total carbon (tC), and lower ratios of  13 C Bicar/Lac + alanine (Ala), and  13 C Bicar/tC than those of the sham-operated control group. Moreover, the necrosis group showed significantly higher ratios of [1- 13 C] Lac/Bicar and [1- 13 C] Lac/tC, and lower ratios of  13 C Bicar/Lac + Ala and  13 C Bicar/tC than those of the AMI/R group. These results were consistent with the pattern for  in vivo  the area under the curve (AUC) ratios. In addition, levels of [1- 13 C] Lac/Bicar and [1- 13 C] Lac/tC were negatively correlated with pH levels, whereas  13 C Bicar/Lac + Ala and  13 C Bicar/tC levels were positively correlated with pH levels. The levels of [1- 13 C] Lac and  13 C Bicar will be helpful for non-invasively evaluating the early stage of AMI/R and necrosis in conjunction with reperfusion injury of the heart. These findings have potential application to real-time evaluation of cardiac malfunction accompanied by changes in intracellular pH level and enzymatic activity.

Metabolic alterations in acute myocardial ischemia-reperfusion injury and necrosis using in vivo hyperpolarized [1-13C] pyruvate MR spectroscopy