Energetics and metabolism in the failing heart: Important but poorly understood

Aslan T. Turer, Craig R. Malloy, Christopher B. Newgard, Mihai V. Podgoreanu

Research output: Contribution to journalReview article

31 Scopus citations

Abstract

Purpose of review: Profound abnormalities in myocardial energy metabolism occur in heart failure and correlate with clinical symptoms and survival. Available comprehensive human metabolic data come from small studies, enrolling patients across heart failure causes, at different disease stages, and using different methodologies, and is often contradictory. Remaining fundamental gaps in knowledge include whether observed shifts in cardiac substrate utilization are adaptive or maladaptive, causal or an epiphenomenon of heart failure. Recent findings: Recent studies have characterized the temporal changes in myocardial substrate metabolism involved in progression of heart failure, the role of insulin resistance, and the mechanisms of mitochondrial dysfunction in heart failure. The concept of metabolic inflexibility has been proposed to explain the lack of energetic and mechanical reserve in the failing heart. Summary: Despite current therapies, which provide substantial benefits to patients, heart failure remains a progressive disease, and new approaches to treatment are necessary. Developing metabolic interventions would be facilitated by systems-level integration of current knowledge on myocardial metabolic control. Although preliminary evidence suggests that metabolic modulators inducing a shift towards carbohydrate utilization seem generally beneficial in the failing heart, such interventions should be matched to the stage of metabolic deregulation in the progression of heart failure.

Original languageEnglish (US)
Pages (from-to)458-465
Number of pages8
JournalCurrent Opinion in Clinical Nutrition and Metabolic Care
Volume13
Issue number4
DOIs
StatePublished - Jul 2010

Keywords

  • glucose metabolism
  • heart failure
  • myocardial energetics

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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