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First published online on December 5, 2003.
 Copyright © 2003 by The Physiological Society
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Received September 15, 2003
Revised October 8, 2003
Accepted after revision December 4, 2003

Energy metabolism in heart failure

Renee F Ventura-Clapier1*, Anne Garnier1, and Vladimir Veksler1

1 U446 INSERM

* To whom correspondence should be addressed. E-mail: renee.ventura{at}cep.u-psud.fr.

Heart failure (HF) is a syndrome resulting from the inability of the cardiac pump to meet the energy requirements of the body. Despite intensive work, the pathogenesis of the cardiac intracellular abnormalities that result from HF remain incompletely understood. Factors that lead to abnormal contraction and relaxation in the failing heart include metabolic pathways abnormalities that results in decreased energy production, energy transfer and energy utilization. Heart failure also affects the periphery. Patients suffering from heart failure always complain of early muscular fatigue and exercise intolerance. This is linked in part to intrinsic alterations of skeletal muscle, among which decreases in the mitochondrial ATP production and in the transfer of energy through the phosphotransfer kinases play an important role. Alterations in energy metabolism that affect both cardiac and skeletal muscles argue for a generalized metabolic myopathy in heart failure. Recent evidence point out that decreased expression of mitochondrial transcription factors and mitochondrial proteins are involved in mechanisms explaining the energy starvation in heart failure. This review will focus on energy metabolism alterations in long term chronic heart failure with only few references to compensated hypertrophy when necessary. It will briefly describe energy metabolism of normal heart and skeletal muscles and their alterations in chronic heart failure. It is beyond the scope of this review to address the metabolic switches occurring in compensated hypertrophy; readers could refer to well documented reviews on this topic (Leong et al. 2003; Taegtmeyer 2000).


Key words: Energy • Heart • Mitochondria




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