Center for Cardiometabolic Science, Christina Lee Brown Envirome Institute, Department of Medicine, University of Louisville, Louisville, KY, USA.
Division of Molecular Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Curr Heart Fail Rep. 2023 Oct;20(5):441-450. doi: 10.1007/s11897-023-00622-0. Epub 2023 Aug 15.
Pregnancy and exercise are systemic stressors that promote physiological growth of the heart in response to repetitive volume overload and maintenance of cardiac output. This type of remodeling is distinct from pathological hypertrophy and involves different metabolic mechanisms that facilitate growth; however, it remains unclear how metabolic changes in the heart facilitate growth and if these processes are similar in both pregnancy- and exercise-induced cardiac growth.
The ability of the heart to metabolize a myriad of substrates balances cardiac demands for energy provision and anabolism. During pregnancy, coordination of hormonal status with cardiac reductions in glucose oxidation appears important for physiological growth. During exercise, a reduction in cardiac glucose oxidation also appears important for physiological growth, which could facilitate shuttling of glucose-derived carbons into biosynthetic pathways for growth. Understanding the metabolic underpinnings of physiological cardiac growth could provide insight to optimize cardiovascular health and prevent deleterious remodeling, such as that which occurs from postpartum cardiomyopathy and heart failure. This short review highlights the metabolic mechanisms known to facilitate pregnancy-induced and exercise-induced cardiac growth, both of which require changes in cardiac glucose metabolism for the promotion of growth. In addition, we mention important similarities and differences of physiological cardiac growth in these models as well as discuss current limitations in our understanding of metabolic changes that facilitate growth.
目的综述：妊娠和运动是系统性应激源，通过重复的容量超负荷和维持心输出量来促进心脏的生理生长。这种重塑与病理性肥大不同，涉及不同的代谢机制来促进生长；然而，目前尚不清楚心脏的代谢变化如何促进生长，以及这些过程在妊娠和运动引起的心脏生长中是否相似。
最新发现：心脏代谢多种底物的能力平衡了心脏对能量供应和合成代谢的需求。在妊娠期间，激素状态与心脏葡萄糖氧化减少的协调对于生理生长似乎很重要。在运动中，心脏葡萄糖氧化的减少似乎对生理生长也很重要，这可能有利于葡萄糖衍生碳进入生长的生物合成途径。了解生理性心脏生长的代谢基础，可以为优化心血管健康和预防不良重塑提供启示，例如产后心肌病和心力衰竭所发生的重塑。本综述重点介绍了已知促进妊娠和运动引起的心脏生长的代谢机制，这两者都需要心脏葡萄糖代谢的变化来促进生长。此外，我们还提到了这两种模型中心脏生理性生长的重要相似和不同之处，并讨论了目前我们对促进生长的代谢变化理解的局限性。
