Chronic Heart Failure

Abstract

Heart Failure is a progressive clinical syndrome marked by venous congestion and maladaptive neurohormonal activation in the setting of left ventricular dysfunction. More recently, another face of this syndrome is beginning to emerge involving metabolic derangements implicating other organs - adipose tissue, skeletal muscle - and the endocrine systems (leptin, adiponectin, insulin and insulin-like growth factor) regulating their mass and function. The metabolic abnormalities which have been described thus far include: 1. Systemic and myocardial insulin resistance (IR); 2. Mitochondrial dysfunction; 3. Progressive weight loss leading to cachexia in the more advanced stages; and 4. Myocardial energetic failure associated with a down-regulation of fatty acid uptake and oxidation resulting in a rigid shift from fatty acid to glucose as the primary energy source for maintenance of ATP flux in the heart - a preferential switch to a fetal-like gene program regulating cardiac energetics. Despite the important advances to date, our understanding of all the components comprising the metabolic phenotype of human heart failure is certainly incomplete, if not rudimentary. (SELECT FULL TEXT TO CONTINUE)