Hyperpolarized 13C Pyruvate-MRI and FDG-PET in a Single Exam for the Prognosis of Ischemic Cardiomyopathy

Study Population Description The study population will consist of 12 to 15 human subjects divided into two main groups. The first group includes 6 healthy individuals with a normal left ventricular ejection fraction (LVEF \> 0.50). The second group comprises 9 patients with advanced ischemic cardiomyopathy (ICM) and a low LVEF (\< 0.40) who are scheduled for standard-of-care Coronary Artery Bypass Graft (CABG) surgery. The study team will aim to recruit a mixed-sex, age-matched population with equal numbers for all metabolic imaging studies. Ischemic Cardiomyopathy (ICM) Patient Cohort Inclusion Criteria: Male or Female, age 18-80 years. Patient scheduled for Coronary Artery Bypass Surgery as standard of care therapy per clinical guidelines. Presence of 1 or more stenotic coronary artery vessels. Left Ventricular Ejection Fraction (LVEF) ≤ 40%, or clinical indication for myocardial viability assessment. Able to tolerate FDG PET/MRI protocol and preparation (e.g., fasting state, glucose regulation). Medication use within 24 hours of the scan is allowed and will be reported. Negative pregnancy test for females of childbearing age (on the day of scanning). No known contraindications to 3T MRI, SPECT MPI, or FDG PET. Exclusion Criteria: Male or female, age \< 18 or \> 80 years of age. Patients not scheduled for CABG or those without confirmed coronary artery disease (CAD). History of prior myocardial infarction with transmural scar \> 50% (based on prior imaging or clinical history). Patient not eligible for 3T MRI (Any condition or device precluding safe MRI e.g., pacemakers, defibrillators, metal implants), SPECT (significant arrhythmias or hemodynamic instability), or FDG-PET (e.g., severely impaired glucose metabolism). Positive pregnancy test or females currently breastfeeding (on the day of scanning). Severe renal impairment (GFR \< 30 mL/min) or contraindication to FDG PET tracer. History of uncontrolled diabetes mellitus (HbA1c \> 9%) or inability to achieve stable glucose levels for FDG PET preparation. Healthy Volunteer Cohort Inclusion Criteria: Male or Female, age 18-80 years. No history of coronary artery disease or diabetes. Eligible for 3T MRI, SPECT, and FDG-PET. Negative pregnancy test for females of childbearing age (on the day of scanning). Exclusion Criteria: History of coronary artery disease, diabetes, or other medical conditions deemed exclusionary by the study team. Positive pregnancy test or females currently breastfeeding (on the day of scanning). Contraindications to MRI (e.g., metallic implants, claustrophobia), SPECT MPI, or FDG-PET.