Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University; State Key Laboratory of Transvascular Implantation Devices; Cardiovascular Key Laboratory of Zhejiang Province, Hangzhou, Zhejiang, 310009, China.
Department of Anesthesiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310009, China.
J Cardiovasc Transl Res. 2024 Feb;17(1):36-55. doi: 10.1007/s12265-023-10443-0. Epub 2023 Oct 16.
The heart is the most energy-demanding organ throughout the whole body. Perturbations or failure in energy metabolism contributes to heart failure (HF), which represents the advanced stage of various heart diseases. The poor prognosis and huge economic burden associated with HF underscore the high unmet need to explore novel therapies targeting metabolic modulators beyond conventional approaches focused on neurohormonal and hemodynamic regulators. Emerging evidence suggests that alterations in metabolic substrate reliance, metabolic pathways, metabolic by-products, and energy production collectively regulate the occurrence and progression of HF. In this review, we provide an overview of cardiac metabolic remodeling, encompassing the utilization of free fatty acids, glucose metabolism, ketone bodies, and branched-chain amino acids both in the physiological condition and heart failure. Most importantly, the latest advances in pharmacological interventions are discussed as a promising therapeutic approach to restore cardiac function, drawing insights from recent basic research, preclinical and clinical studies.
心脏是全身能量需求最高的器官。能量代谢的紊乱或衰竭会导致心力衰竭（HF），这代表了各种心脏病的晚期阶段。HF 与预后不良和巨大的经济负担相关，这突显了探索新型治疗方法的巨大需求，这些方法针对代谢调节剂，而不仅仅是传统的针对神经激素和血液动力学调节剂的方法。新出现的证据表明，代谢底物依赖性、代谢途径、代谢副产物和能量产生的改变共同调节 HF 的发生和进展。在这篇综述中，我们概述了心脏代谢重构，包括在生理条件和心力衰竭下游离脂肪酸、葡萄糖代谢、酮体和支链氨基酸的利用。最重要的是，讨论了药理学干预的最新进展，作为一种有前途的恢复心脏功能的治疗方法，这一方法借鉴了最近的基础研究、临床前和临床研究的见解。
