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

Turer, Aslan Ta; Malloy, Craig Ra,b,c,d; Newgard, Christopher Be,f; Podgoreanu, Mihai Vg

Current Opinion in Clinical Nutrition and Metabolic Care: July 2010 - Volume 13 - Issue 4 - p 458–465
doi: 10.1097/MCO.0b013e32833a55a5
Carbohydrates: David D'Alessio and Luc Tappy

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.

aDivision of Cardiology, USA

bAdvanced Imaging Research Center, USA

cDepartment of Radiology, University of Texas Southwestern Medical Center, USA

dVA North Texas Healthcare System, Texas, USA

eSarah W. Stedman Nutrition and Metabolism Center, USA

fDepartments of Pharmacology and Cancer Biology, USA

gDivision of Cardiothoracic Anesthesia and Critical Care, Duke Perioperative Genomics Program, Duke University Medical Center, North Carolina, USA

Correspondence to Aslan T. Turer, 5323 Harry Hines Blvd, Dallas, TX 75390-9047, USA Tel: +1 214 645 7558; fax: +1 214 645 7501; e-mail:

© 2010 Lippincott Williams & Wilkins, Inc.