Is the Failing Heart Energy Starved?

Key Result

Myocardial ATP metabolism and its energetic changes in the failing heart are reviewed, highlighting the causes, consequences, and opportunities for future basic and clinical research.

Key Points

• To review the mechanisms of myocardial ATP metabolism and evaluate the causes and consequences of energetic impairment in the failing heart.
• Reviewed foundational physiology of myocardial ATP production, transfer, and utilization during systolic and diastolic work.
• Synthesized current basic and clinical evidence regarding metabolic remodeling, ATP deficiency, and energy flux in failing cardiac tissue.
• Cardiac mechanical performance relies continuously on uninterrupted ATP synthesis to sustain both contraction and active relaxation.
• The failing heart undergoes significant disruptions in ATP metabolic pathways, leading to energetic impairment that exacerbates functional decline.