Myocardial glucose metabolic pathway

The myocardial glucose metabolic pathway is a critical biochemical network responsible for the uptake, breakdown, and oxidation of glucose within cardiac myocytes to generate adenosine triphosphate (ATP) (Lopaschuk et al., 2021, Physiological Reviews). While the healthy heart primarily relies on fatty acid oxidation for energy, it maintains metabolic flexibility to switch to glucose oxidation under stress, ischemia, or increased workload (Stanley et al., 2005, Physiological Reviews). In pathological states such as heart failure or diabetic cardiomyopathy, the heart often becomes metabolically inefficient, and therapeutic strategies aim to enhance glucose metabolism because it requires less oxygen per mole of ATP produced compared to fatty acids (Kolwicz et al., 2013, Circulation Research). Key regulatory points in this pathway include glucose transporters (GLUT1 and GLUT4), the glycolytic cascade, and the pyruvate dehydrogenase (PDH) complex, which serves as the rate-limiting step for glucose oxidation (NIH/StatPearls: Myocardial Metabolism). Modulating these steps with drugs like trimetazidine or SGLT2 inhibitors can improve cardiac efficiency and provide cardioprotection during ischemic events by optimizing energy substrate utilization (Lopaschuk et al., 2021).

Other names

Cardiac glucose metabolismMyocardial glucose uptake and oxidationCardiac glycolysisMyocardial carbohydrate metabolism

Modulation of myocardial substrate utilization by shifting the heart's preference from fatty acid oxidation to glucose oxidation, increasing glucose uptake via GLUT transporters, or activating the pyruvate dehydrogenase complex to enhance oxygen-efficient ATP production.