Investigation of cardiac metabolism in patients with heart failure using hyperpolarized MRI

Lab values

• Not able or willing to receive heart failure therapy Patients not willing to participate Uncontrolled serious medical condition, such as uncontrolled heart disease, uncontrolled diabetes, intestinal obstruction, uncontrolled hypertension, or recent cerebral ischemia Receiving more than 50% of taget dose of ACE-inhibitor and betablockers before inclusion in study 1 (this does not apply for substudy 1A) Estimated Glomerular Filtration Rate (eGFR) <30 mL/min Insulin dependent Diabetes Mellitus Intolerance to Pyruvate

• Chronic heart failure (Heart failure with both reduced and preserved EF are allowed) > 18 years of age. Left ventricular Ejection Fraction (LVEF) of 10 – 60 % Adequate hematologic and organ function, i.e. ANC at least 1.500/uL Platelet count >100/uL Se creatinine up to 1.5 x UNL or creatinine clearance at least 30 ml/min Women who are not postmenopausal or surgically sterile must have a negative serum or urine pregnancy test performed at time of inclusion in the study. Safe and highly effective contraception must be used throughout the study meaning either hormonal anti-conception or an anti-fertility intrauterine device. If the partner is non fertile or the patient has no sexual activities, this is also accepted. Non-insulin dependent Diabetes mellitus is allowed Danish speaking Able and willing to comply after informed consent For substudy 1A only: Ischemic heart disease and referral to viability testing at the Department of Clinical Physiology and Nuclear Medicine at Aarhus University Hospital, Skejby.