State Key Laboratory of Cardiovascular Disease, Fuwai Hospital; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), 167A Beilishi Road, Xi Cheng District, Beijing, 100037, People's Republic of China.
Heart Fail Rev. 2019 Jan;24(1):143-154. doi: 10.1007/s10741-018-9713-0.
Heart failure (HF) is a clinical syndrome caused by a decline in cardiac systolic or diastolic function, which leaves the heart unable to pump enough blood to meet the normal physiological requirements of the human body. It is a serious disease burden worldwide affecting nearly 23 million patients. The concept that heart failure is "an engine out of fuel" has been generally accepted and metabolic remodeling has been recognized as an important aspect of this condition; it is characterized by defects in energy production and changes in metabolic pathways involved in the regulation of essential cellular functions such as the process of substrate utilization, the tricarboxylic acid cycle, oxidative phosphorylation, and high-energy phosphate metabolism. Advances in second-generation sequencing, proteomics, and metabolomics have made it possible to perform comprehensive tests on genes and metabolites that are crucial in the process of HF, thereby providing a clearer and comprehensive understanding of metabolic remodeling during HF. In recent years, new metabolic changes such as ketone bodies and branched-chain amino acids were demonstrated as alternative substrates in end-stage HF. This systematic review focuses on changes in metabolic substrate utilization during the progression of HF and the underlying regulatory mechanisms. Accordingly, the conventional concepts of metabolic remodeling characteristics are reviewed, and the latest developments, particularly multi-omics studies, are compiled.
心力衰竭（HF）是一种由心肌收缩或舒张功能下降引起的临床综合征，导致心脏无法泵出足够的血液来满足人体的正常生理需求。它是一种严重的全球疾病负担，影响着近 2300 万患者。心力衰竭是“燃料不足的引擎”这一概念已被普遍接受，代谢重构已被认为是这种情况的一个重要方面；其特征是能量产生缺陷和参与调节基本细胞功能的代谢途径的变化，如底物利用、三羧酸循环、氧化磷酸化和高能磷酸代谢过程。第二代测序、蛋白质组学和代谢组学的进展使得对心力衰竭过程中至关重要的基因和代谢物进行全面测试成为可能，从而更清楚、更全面地了解心力衰竭期间的代谢重构。近年来，酮体和支链氨基酸等新的代谢变化被证明是终末期心力衰竭的替代底物。本系统综述重点关注心力衰竭进展过程中代谢底物利用的变化及其潜在的调节机制。因此，本文回顾了代谢重构特征的传统概念，并编译了最新的研究进展，特别是多组学研究。
