Mechanistic Studies of Lactate in Heart Failure: From Metabolic Biomarker to Therapeutic Target

Heart failure (HF) is a significant cardiovascular syndrome with a high prevalence of morbidity and mortality across the globe. Meanwhile, lactate, a byproduct of glycolysis, has been implicated in myocardial hypoxia and disarranged energy metabolism and has drawn attention in the context of HF. In addition to serving as a highly sensitive biomarker, lactate might also contribute to myocardial remodeling and inflammation via multiple signaling pathways, thereby affecting disease course and prognosis; however, the mechanisms through which lactate impacts HF remain incompletely elucidated, and published results are contradictory. Therefore, this review encompassed lactate metabolism and the associated physiological and pathological functions in HF, underlining the clinical significance of lactate as a metabolic biomarker. Moreover, this review discussed recent progress targeting lactate metabolism or lactylation as potential treatments to promote a clearer understanding of the mechanistic aspects of metabolic regulation in HF and to guide clinical diagnosis and treatment.