Modification of myocardial substrate use as a therapy for heart failure.
Despite advances in treatment, chronic heart failure is still associated with significant morbidity and a poor prognosis. The scope for further advances based on additional neurohumoral blockade is small. Effective adjunctive therapies acting via a different cellular mechanism would, therefore, be attractive. Energetic impairment seems to contribute to the pathogenesis of heart failure. The findings from several studies have shown that the so-called metabolic agents could have potential as adjunctive therapies in heart failure. These agents cause a shift in the substrate used by the heart away from free fatty acids, the oxidation of which normally provides around 70% of the energy needed, towards glucose. The oxygen cost of energy generation is lessened when glucose is used as the substrate. In this review we aim to draw attention to the metabolic alteration in heart failure and we present evidence supporting the use of metabolic therapy in heart failure.
Abozguia
Khalid
K
Department for Cardiovascular Medicine, University of Birmingham, Birmingham, UK. k.abozguia@bham.ac.uk
Clarke
Kieran
K
Lee
Leong
L
Frenneaux
Michael
M
D000083:Acetanilides; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000818:Animals; D002303:Cardiac Output, Low / Q000188:drug therapy* / Q000378:metabolism; D002317:Cardiovascular Agents / Q000494:pharmacology* / Q000627:therapeutic use; D004734:Energy Metabolism / Q000187:drug effects*; D004852:Epoxy Compounds / Q000627:therapeutic use; D005230:Fatty Acids, Nonesterified / Q000378:metabolism; D005998:Glycine / Q000031:analogs & derivatives / Q000627:therapeutic use; D006321:Heart / Q000187:drug effects*; D006801:Humans; D009206:Myocardium / Q000378:metabolism*; D010100:Oxygen / Q000378:metabolism; D010480:Perhexiline / Q000627:therapeutic use; D010879:Piperazines / Q000627:therapeutic use; D000069458:Ranolazine; D014292:Trimetazidine / Q000627:therapeutic use
D000083:Acetanilides; D000319:Adrenergic beta-Antagonists; D002317:Cardiovascular Agents; D004852:Epoxy Compounds; D005230:Fatty Acids, Nonesterified; D010879:Piperazines; C023010:4-hydroxyphenylglycine; D000069458:Ranolazine; D010480:Perhexiline; C054207:etomoxir; D014292:Trimetazidine; D010100:Oxygen; D005998:Glycine