title: Metabolic impairment in heart failure: the myocardial and systemic perspective.
abstract: Although bioenergetic starvation is not a new concept in heart failure (HF), recent research has led to a growing appreciation of the complexity of metabolic aspects of HF pathophysiology. All steps of energy extraction, transfer, and utilization are affected, and structural metabolism is impaired, leading to compromised functional integrity of tissues. Not only the myocardium, but also peripheral tissues and organs are affected by metabolic failure, resulting in a global imbalance between catabolic and anabolic signals, leading to tissue wasting and, ultimately, to cachexia. Metabolic feedback signals from muscle and fat actively contribute to further myocardial strain, promoting disease progression. The prolonged survival of patients with stable, compensated HF will increasingly bring chronic metabolic complications of HF to the fore and gradually shift its clinical presentation. This paper reviews recent evidence on myocardial and systemic metabolic impairment in HF and summarizes current and emerging therapeutic concepts with specific metabolic targets.
authors.affiliation: Centre for Stroke Research Berlin and Department of Cardiology, Campus Virchow-Klinikum Charité-Universitätsmedizin Berlin, Berlin, Germany. Electronic address: wolfram.doehner@charite.de.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Doehner
authors.affiliation: University of Aberdeen School of Medicine and Dentistry, Aberdeen, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Frenneaux
authors.affiliation: Department of Innovative Clinical Trials, University Medical Centre, Göttingen, Germany.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
mesh_terms: D002100:Cachexia; D018450:Disease Progression; D004734:Energy Metabolism; D013006:Growth Hormone / Q000378:metabolism; D006333:Heart Failure / Q000503:physiopathology*; D006801:Humans; D007333:Insulin Resistance; D018482:Muscle, Skeletal / Q000473:pathology; D009206:Myocardium / Q000378:metabolism*; D011379:Prognosis; D055948:Sarcopenia / Q000503:physiopathology; D013256:Steroids / Q000378:metabolism; D020521:Stroke / Q000503:physiopathology
chemical_list: D013256:Steroids; D013006:Growth Hormone
keywords: cachexia; insulin resistance; metabolism; muscle; sarcopenia; stroke