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Metabolic Therapy for the Ischemic Heart

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Book cover Cardiac Energy Metabolism in Health and Disease

Part of the book series: Advances in Biochemistry in Health and Disease ((ABHD,volume 11))

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Abstract

Myocardial ischemia is universally accepted to be the result of an imbalance between oxygen supply and requirements to the myocardium. The presence of flow limiting coronary stenosis is the main recognized pathological mechanism underlying this condition. While revascularization procedures are performed with the aim to remove the flow limiting stenosis, traditional medical therapy with hemodynamic agents aim at reducing oxygen demand of the myocardium. However, although effective, none of these treatment strategies or their combination confers symptomatic relief in all patients, in this way underlying the need for further research in this area.

Metabolic derangement is critical in patients who presents with ischemic heart disease (IHD). Under normal conditions the heart derives most of its energy from β-oxidation of free fatty acids (FA). However, the healthy heart is able to easily switch from one substrate to another according to substrate availability, nutritional status, and exercise level. Paradoxically, during prolonged and severe ischemia the myocardium continues to derive most of its energy (50–70 %) from β-oxidation, despite a high rate of lactate production. At this stage it is believed that FA oxidation can turn to be detrimental in that, while requiring more oxygen, it produces less ATP. Given such metabolic derangements, pharmacological approaches aimed at rebalancing myocardial metabolism may play a key role in treatment of patients with IHD. In this scenario, therapeutic interventions aiming at a shift of myocardial substrate utilization towards glucose metabolism would particularly benefit cardiac efficiency and IHD symptoms. In the next session principal metabolic agents will be discussed to further address their role in IHD.

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Authors and Affiliations

  1. Cardio Thoracic and Vascular Department, Cardiovascular Medicine Division, University of Pisa, Via Paradisa n 2, 56100, Pisa, Italy

    Giacinta Guarini, Alda Huqi & Mario Marzilli

Authors
  1. Giacinta Guarini
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  2. Alda Huqi
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  3. Mario Marzilli
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Correspondence to Mario Marzilli .

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Editors and Affiliations

  1. Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada

    Gary D. Lopaschuk

  2. University of Manitoba, Institute of Cardiovascular Sciences, St. Boniface Hospital Research, Winnipeg, Manitoba, Canada

    Naranjan S. Dhalla

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Guarini, G., Huqi, A., Marzilli, M. (2014). Metabolic Therapy for the Ischemic Heart. In: Lopaschuk, G., Dhalla, N. (eds) Cardiac Energy Metabolism in Health and Disease. Advances in Biochemistry in Health and Disease, vol 11. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-1227-8_15

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