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Cardiovascular Research Advance Access first published online on October 14, 2008
This version [Corrected Proof] published online on November 6, 2008
Cardiovascular Research, doi:10.1093/cvr/cvn282
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org.

Metabolic remodelling of the failing heart: beneficial or detrimental?

Marc van Bilsen*, Frans A. van Nieuwenhoven and Ger J. van der Vusse

Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands

* Corresponding author. Tel: +31 43 388 1204; fax: +31 43 388 4166. E-mail address: marc.vanbilsen{at}fys.unimaas.nl

The failing heart is characterized by alterations in energy metabolism, including mitochondrial dysfunction and a reduction in fatty acid (FA) oxidation rate, which is partially compensated by an increase in glucose utilization. Together, these changes lead to an impaired capacity to convert chemical energy into mechanical work. This has led to the concept that supporting cardiac energy conversion through metabolic interventions provides an important adjuvant therapy for heart failure. The potential success of such a therapy depends on whether the shift from FA towards glucose utilization should be considered beneficial or detrimental, a question still incompletely resolved. In this review, the current status of the literature is evaluated and possible causes of observed discrepancies are discussed. It is cautiously concluded that for the failing heart, from a therapeutic point of view, it is preferable to further stimulate glucose oxidation rather than to normalize substrate metabolism by stimulating FA utilization. Whether this also applies to the pre-stages of cardiac failure remains to be established.

KEYWORDS Hypertrophy; Energy metabolism; Mitochondria; Fatty acids; Glucose; Peroxisome proliferator-activated receptor

Time for primary review: 16 days


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