Myocardial metabolic pathways

Myocardial metabolic pathways encompass the integrated biochemical processes, including fatty acid oxidation, glucose oxidation, and the citric acid cycle, that provide the high levels of adenosine triphosphate (ATP) required for continuous cardiac contraction (Stanley et al., 2005, Physiological Reviews). The heart is a metabolic omnivore, capable of utilizing various substrates to maintain energy homeostasis, though it primarily relies on fatty acids (60-90%) under normal physiological conditions (Lopaschuk et al., 2010, Physiological Reviews). In pathological states such as heart failure or myocardial ischemia, these pathways become dysregulated, leading to a loss of metabolic flexibility, energy deficiency, and impaired contractile function (Neubauer, 2007, NEJM). Therapeutic strategies targeting these pathways, often referred to as metabolic modulation, aim to optimize energy production by shifting substrate utilization toward more oxygen-efficient pathways like glucose oxidation. This approach is intended to improve myocardial efficiency and provide cardioprotection without directly altering hemodynamics or heart rate (StatPearls, 2023, Myocardial Metabolism).

Other names

Cardiac metabolismMyocardial energy metabolismCardiac energy substrate metabolismHeart metabolic pathways

Modulation of substrate preference, typically through the partial inhibition of fatty acid oxidation (p-FOX inhibitors) to secondary stimulate glucose oxidation, thereby improving oxygen efficiency in ATP production.