Non-proton spectroscopy is a powerful tool that allows the assessment of
specific and significant metabolites in cardiac tissue, such as key intermediates in
energy metabolism. The technique uses spectroscopy, or less often imaging, of nuclei
such as 31P, 19F and 23Na. Due to the non-invasive nature of MRS, the technique is also
applicable in the clinic, where it is used to assess changes in cardiac metabolism, such
as due to a heart infarct. This chapter reviews the main developments in non-proton
cardiac MRS and MRI, both clinical and preclinical. Major issues and challenges are
also summarized. Finally, the promise of exciting new developments, particularly
hyper-polarization, is discussed.
Keywords: 19F, 23Na, 31P, ATP, chemical shift, clinical, energy metabolism,
hyperpolarization, lanthanide, metabolism, MRS, spectroscopy, multimodal,
NMR, noninvasive, non-proton, preclinical, quantification, sensitivity, spectrum.
