Related Experiment Video
Updated: Jun 18, 2026
Methods for the Determination of Rates of Glucose and Fatty Acid Oxidation in the Isolated Working Rat Heart
Published on: September 28, 2016
Alterations in Cardiac and Systemic Metabolism in Heart Failure
Edoardo Bertero1,2, Federico Capone3,4,5, Ambra Costa1
1Ospedale Policlinico San Martino, IRCCS Azienda Ospedaliera Metropolitana, Genova, Italy (E.B., A.C., P.A.).
Insights
Heart failure (HF) involves significant changes in cardiac and systemic metabolism. Emerging therapies may restore metabolic balance, improving heart function in HF patients.
Area of Science:
- Cardiology
- Metabolic Science
- Biochemistry
Background:
- Altered cardiac and systemic metabolism characterize heart failure (HF).
- Cardiomyocytes in HF exhibit impaired substrate preference, mitochondrial function, and energy transfer.
- Systemic metabolic disruptions, including neurohormonal activation and comorbidities, impact HF progression.
Purpose of the Study:
- To review cardiac metabolism alterations in HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF).
- To examine the role of interorgan communication in myocardial function during HF.
- To highlight the metabolic mechanisms of novel HF therapies.
Main Methods:
- Literature review focusing on cardiac and systemic metabolism in HF.
- Comparative analysis of metabolic changes in HFrEF versus HFpEF.
- Discussion of emerging therapeutic strategies targeting metabolic pathways.
Main Results:
- HF involves distinct substrate metabolism alterations in HFrEF and HFpEF.
- Interorgan metabolic crosstalk significantly influences myocardial function in HF.
- Novel therapies like SGLT2 inhibitors and GLP-1 RAs show promise in restoring metabolic homeostasis.
Conclusions:
- Understanding cardiac metabolism is crucial for HF management.
- Targeting metabolic pathways offers a promising therapeutic avenue for HF.
- Restoration of metabolic homeostasis is a key mechanism for new HF treatments.
Abstract:
Altered cardiac and systemic metabolism is a hallmark of heart failure (HF). In the failing heart, cardiomyocytes develop alterations in substrate preference, mitochondrial oxidative metabolism, and the shuttling of high-energy phosphates from mitochondria to the cytosol that compromise energetic efficiency and contribute to disease progression. At the systemic level, neurohormonal activation plays a dominant role in HF with reduced ejection fraction, whereas HF with preserved ejection fraction is shaped by the clustering of multiple comorbidities, such as diabetes, obesity and hypertension, which disrupt the physiological crosstalk between the heart and metabolically active organs. This review provides a perspective on cardiac metabolism in HF. We delineate the specific alterations in substrate metabolism that characterize HF with reduced ejection fraction versus HF with preserved ejection fraction, examine the impact of interorgan communication on myocardial function, and highlight how the benefits of emerging HF therapies, including sodium-glucose cotransporter 2 inhibitors and glucagon-like peptide 1 receptor agonists, may be mediated, at least in part, through the restoration of metabolic homeostasis.
Related Concept Videos
01:17Pathophysiology of Heart Failure
01:27Heart Failure I: Introduction
01:29Heart Failure II: Pathophysiology
01:26Imbalances in Cardiac Output
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...
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:30Heart Failure V: Medical Management