Pleiotropic Effects of Cardiac Resynchronization Therapy on Cardiometabolic Modulation in Heart Failure
Panagiotis Theofilis1, Panagiotis Iliakis1, Aikaterini-Eleftheria Karanikola1
1First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 115 27 Athens, Greece.
Medicina (Kaunas, Lithuania)
|March 28, 2026
Summary
Cardiac resynchronization therapy (CRT) improves heart failure outcomes by enhancing mechanical efficiency and restoring cardiometabolic function. This therapy normalizes energy metabolites and improves substrate utilization, benefiting patients with advanced heart failure.
Area of Science:
- Cardiology
- Metabolic Medicine
- Biomedical Engineering
Background:
- Cardiac resynchronization therapy (CRT) is a key treatment for heart failure (HF) patients with electrical dyssynchrony.
- Evidence suggests CRT offers benefits beyond mechanical synchrony, impacting cardiometabolic processes.
Purpose of the Study:
- To review the emerging data on how CRT influences myocardial energy metabolism.
- To discuss CRT's effects on ventricular-arterial interactions and peripheral metabolic pathways.
Main Methods:
- Review of existing literature on CRT's metabolic and mechanical effects.
- Analysis of metabolomic profiling studies in CRT patients.
- Correlation of metabolic changes with cardiac remodeling and function.
Main Results:
- CRT enhances myocardial efficiency and shifts substrate utilization towards fatty acids and ketones.
- Metabolomic studies show CRT normalizes energy metabolites and improves glucose-lipid balance.
- Metabolic adaptations correlate with improved diastolic function, RV function, and ventriculo-arterial coupling.
Conclusions:
- CRT provides both mechanical and metabolic restoration in advanced heart failure.
- CRT reconditions myocardial energy metabolism and influences systemic metabolic pathways.
- Understanding these mechanisms may help differentiate CRT responders and optimize therapy.
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