Hyperpolarized MR may be a key tool for investigation cardiac metabolism and cardiac treatment response. [1,4-13C2]Fumarate is an emerging and interesting candidate for measuring and visualizing cardiac injury after ischemia. In this study we showed an initial step for imaging cardiac cell death in a large animal model with [1,4-13C2]malate. The [1,4-13C2]malate signal correlated well with increased 13C-lactate signal and 13C-alanine absence. Overall, this shows increased metabolism in the infarcted area and ongoing necrosis.
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