Energy balance
In heart failure, the failing heart shifts from efficient fatty acid oxidation to inefficient glycolysis, leading to acidosis, ion overload, and reduced ATP production, which exacerbates cardiac dysfunction.
In heart failure, the heart's energy system breaks down, relying on inefficient processes that create toxic byproducts (acidosis) and reduce power (ATP). This metabolic shift worsens the heart's ability to pump. Treatments targeting this metabolic inflexibility (like ketone bodies or specific drugs) may help, but the core issue is the heart's inability to efficiently burn fuel.
In heart failure, there is an increase in glycolysis, but a decrease in glucose oxidation. This is because the failing heart has a decreased mitochondrial oxidative capacity and impaired activity of pyruvate dehydrogenase (PDH). The decrease in glucose oxidation leads to a reduction in ATP production.
Why this rating
Narrative review synthesizing human and animal studies on cardiac metabolism.
Source
Metabolic flexibility and insulin resistance
José E. Galgani et al. · American Journal of Physiology-Endocrinology and Metabolism · 2008
DOI 10.1152/ajpendo.90558.2008
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