This study explored the safety and feasibility to visualize real-time myocardial Krebs cycle energetics in healthy volunteers using hyperpolarized [2-13C]pyruvate MR spectroscopy, and to investigate the response to oral glucose challenge. Identified metabolic products included [2-13C]lactate, Krebs cycle-related intermediate [5-13C]glutamate, and [1-13C]acetylcarnitine, a key player in the “carnitine shuttle” of mitochondrial fatty acid oxidation. Upon oral glucose challenge, the levels of all three products increased, illustrating the metabolic flexibility of human heart to switch between fatty acid and carbohydrates.
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