A metabocentric view of cardiac remodeling

Physiologic and pathologic stressors promote changes in metabolism that are associated with cardiac remodeling. Metabolic alterations in the heart are a summation of responses of several organs and organ systems, which transform the milieu of circulating substrates and stimuli and prompt cardiac adaptation or remodeling. Nevertheless, the mechanisms by which metabolism causes cardiac remodeling remain unclear. Difficulties in delineating metabolic mechanisms of tissue remodeling are in part due to technical issues as well as to the lack of conceptual clarity with regard to causal entailment of metabolic processes. This review discusses some metabolic mechanisms by which stressors such as exercise, pregnancy, and pressure overload promote metabolism-mediated cardiac remodeling. Adopting conceptual frameworks based in relational biology and delineating hierarchies of metabolic causation could lend new insight into how metabolism coordinates cardiac remodeling.