Myocardial Substrate Metabolism in the Normal and Failing Heart

The alterations in myocardial energy substrate metabolism that occur in heart failure, and the causes and consequences of these abnormalities, are poorly understood. There is evidence to suggest that impaired substrate metabolism contributes to contractile dysfunction and to the progressive left ventricular remodeling that are characteristic of the heart failure state. The general concept that has recently emerged is that myocardial substrate selection is relatively normal during the early stages of heart failure; however, in the advanced stages there is a downregulation in fatty acid oxidation, increased glycolysis and glucose oxidation, reduced respiratory chain activity, and an impaired reserve for…

• CW
  Case Western Reserve University
• SO
  School of Medicine, Case Western Reserve University
• FP
  Fondation pour la Recherche Médicale
• S
  Servier
• NH
  National Heart, Lung, and Blood Institute