Effects on global metabolism by regulation of substrate utilization in heart failure

Ferdinando Loiacono, Carmela Silipigni, Matteo Pagnesi, Gabriele Fragasso

Research output: Contribution to journalArticlepeer-review


In patients with chronic heart failure, exertional intolerance is a major clinical problem. Muscle factors that limit exercise capacity are unrelated to central hemodynamics. While cardiac cachexia represents the most extreme form of loss of muscle mass in chronic heart failure, a more subtle form of lean body mass changes clearly exists, as is evident by the loss of skeletal muscle observed in patients with non-cachectic congestive heart failure. Previous studies have shown that pharmacological manipulation of cardiac substrate utilization with agents that directly inhibit fatty acid oxidation could improve cardiac function and, accordingly, global metabolism efficiency, The most extensively investigated agent of this group of drugs is trimetazidine, a 3-ketoacyl-coenzyme A thiolase (3-KAT) inhibitor. Clinical studies have shown that shifting the energy substrate preference away from fatty acid metabolism and toward glucose metabolism by 3-KAT inhibitors could be an effective adjunctive treatment in patients with heart failure in terms of left ventricular function and global metabolism improvement. In this article, the recent literature on the beneficial effects of this new potential use of 3-KAT inhibitors on left ventricular dysfunction and global metabolism is reviewed and discussed.

Original languageEnglish
Pages (from-to)23-27
Number of pages5
JournalHeart and Metabolism
Issue number64
Publication statusPublished - 2014


  • Diabetes
  • Global metabolism
  • Heart failure
  • Left ventricular function
  • Trimetazidine

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Endocrinology, Diabetes and Metabolism


Dive into the research topics of 'Effects on global metabolism by regulation of substrate utilization in heart failure'. Together they form a unique fingerprint.

Cite this