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We investigated whether [1\u2010<jats:sup>13<\/jats:sup>C]pyruvate MRS could predict left ventricular remodeling following myocardial infarction (MI), long\u2010term left ventricular effects of heart failure medication, and could identify responders to treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty\u2010five rats were scanned with hyperpolarized [1\u2010<jats:sup>13<\/jats:sup>C]pyruvate MRS 3 days after MI or sham surgery. The animals were re\u2010examined after 30 days of therapy with \u03b2\u2010blockers and ACE\u2010inhibitors (active group, <jats:italic>n<\/jats:italic> = 12), placebo treatment (placebo group, <jats:italic>n<\/jats:italic> = 13) or no treatment (sham group, <jats:italic>n<\/jats:italic> = 10). Furthermore, heart tissue mitochondrial respiratory capacity was assessed by high\u2010resolution respirometry. Metabolic results were compared between groups, over time and correlated to functional MR data at each time point.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>At 30 \u00b1 0.5 days post MI, left ventricular ejection fraction (LVEF) differed between groups (sham, 77% \u00b1 1%; placebo, 52% \u00b1 3%; active, 63% \u00b1 2%, <jats:italic>P<\/jats:italic> &lt; .001). Cardiac metabolism, measured by both hyperpolarized [1\u2010<jats:sup>13<\/jats:sup>C]pyruvate MRS and respirometry, neither differed between groups nor between baseline and follow\u2010up. Three days post MI, low bicarbonate + CO<jats:sub>2<\/jats:sub>\/pyruvate ratio was associated with low LVEF. At follow\u2010up, in the active group, a poor recovery of LVEF was associated with high bicarbonate + CO<jats:sub>2<\/jats:sub>\/pyruvate ratio, as measured by hyperpolarized MRS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In a rat model of moderate heart failure, medical treatment improved function, but did not on average influence [1\u2010<jats:sup>13<\/jats:sup>C]pyruvate flux as measured by MRS; however, responders to heart failure medication had reduced capacity for carbohydrate metabolism.<\/jats:p><\/jats:sec>","DOI":"10.1002\/mrm.28964","type":"journal-article","created":{"date-parts":[[2021,8,11]],"date-time":"2021-08-11T11:01:42Z","timestamp":1628679702000},"page":"57-69","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Remodeling after myocardial infarction and effects of heart failure treatment investigated by hyperpolarized [1\u2010<sup>13<\/sup>C]pyruvate magnetic 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