Metabolic management of heart disease

Alterations of cardiac metabolism occur with ischemia and heart failure (HF). This results in increased utilization of noncarbohydrate substrates for energy production and depletion of myocardial adenosine triphosphate, phosphocreatine, and creatine kinase with decreased efficiency of mechanical work. A direct approach to manipulate cardiac energy metabolism consists in modifying substrate utilization by the failing heart. The results of research suggest that shifting the energy substrate preference away from fatty acid metabolism and toward glucose metabolism could be an effective adjunctive treatment in patients with HF, in terms of left ventricular function and glucose metabolism improvement. In this paper, some of these concepts will be discussed, and the role of drugs such as trimetazidine will be discussed