Related Experiment Video

Updated: Jun 23, 2026

Methods for the Determination of Rates of Glucose and Fatty Acid Oxidation in the Isolated Working Rat Heart
12:24

Methods for the Determination of Rates of Glucose and Fatty Acid Oxidation in the Isolated Working Rat Heart

Published on: September 28, 2016

Metabolic mechanisms in heart failure

Houman Ashrafian1, Michael P Frenneaux, Lionel H Opie

  • 1Department of Cardiovascular Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK. houman.ashrafian@cardiov.ox.ac.uk

Circulation
|July 25, 2007
PubMed

Insights

Heart failure can worsen metabolism and insulin resistance, creating a harmful cycle. New therapies targeting these metabolic changes may improve heart function and reduce mortality.

Area of Science:

  • Cardiology
  • Metabolic Medicine
  • Biochemistry

Background:

  • Neurohumoral antagonism has improved heart failure outcomes but residual mortality remains high.
  • Heart failure is linked to metabolic abnormalities, including insulin resistance, potentially driven by neurohumoral activation.
  • A detrimental cycle of heart failure promoting metabolic changes, which in turn worsen heart failure, is hypothesized.

Purpose of the Study:

  • To review the cellular mechanisms and pathophysiology of altered metabolism and insulin resistance in heart failure.
  • To explore how these metabolic changes contribute to the progression of heart failure.
  • To discuss current and novel therapeutic strategies targeting metabolic dysfunction in heart failure.

Main Methods:

  • Review of existing literature on myocardial metabolism, insulin resistance, and heart failure pathophysiology.
  • Analysis of cellular mechanisms linking neurohumoral activation to metabolic perturbations.
  • Discussion of therapeutic interventions aimed at mitigating aberrant metabolism.

Main Results:

  • Heart failure can induce insulin resistance and alter myocardial substrate utilization, favoring free fatty acid over glucose metabolism.
  • These metabolic changes lead to reduced myocardial energy (ATP, phosphocreatine) and impaired mechanical efficiency.
  • Neurohumoral activation, adverse fatty acid metabolism, and insulin resistance are key contributors to myocardial energetic deficits.

Conclusions:

  • Altered myocardial metabolism and insulin resistance represent a critical, self-perpetuating aspect of heart failure progression.
  • Therapies including neurohumoral antagonism, lifestyle modifications, and novel metabolic modulators show promise.
  • Targeting metabolic pathways offers a potential strategy to further reduce mortality and improve cardiac function in heart failure patients.

More Related Videos

A Model of Cardiac Remodeling Through Constriction of the Abdominal Aorta in Rats07:31

A Model of Cardiac Remodeling Through Constriction of the Abdominal Aorta in Rats

Published on: December 2, 2016

A Modified Technique for Transverse Aortic Constriction in Mice04:52

A Modified Technique for Transverse Aortic Constriction in Mice

Published on: August 18, 2022

Related Concept Videos

Pathophysiology of Heart Failure01:17

Pathophysiology of Heart Failure

Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
Heart Failure Drugs: Inhibitors of Renin-Angiotensin System01:26

Heart Failure Drugs: Inhibitors of Renin-Angiotensin System

The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
Imbalances in Cardiac Output01:26

Imbalances in Cardiac Output

The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send blood...
Heart Failure I: Introduction01:27

Heart Failure I: Introduction

Heart failure refers to a clinical syndrome caused by structural or functional cardiac disorders that prevent the heart from pumping an adequate amount of blood to meet the body's metabolic needs. This condition often arises from myocardial infarction or ischemia, leading to decreased cardiac output, reduced tissue perfusion, impaired gas exchange, fluid volume imbalance, and decreased functional ability.Heart failure can result from disruptions in the mechanisms that regulate cardiac output...
Heart Failure II: Pathophysiology01:29

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...
Heart Failure V: Medical Management01:30

Heart Failure V: Medical Management

Medical Management of Acute Decompensated Heart Failure (ADHF)The primary goals of therapy for patients hospitalized with acute decompensated heart failure (ADHF) include:Relieving symptomsOptimizing volume statusSupporting oxygenation and ventilationMaintaining cardiac output (CO) and end-organ perfusionIdentifying and addressing the cause of ADHFPreventing complicationsProviding patient education on factors precipitating HF exacerbationPlanning for dischargeOngoing monitoring and assessment...