Is chronic heart failure a reversible metabolic syndrome?

Heart failure is a progressive syndrome marked by systemic and pulmonary venous congestion, and maladaptive neuroendocrine activation in the setting of structural heart disease. Another facet of this syndrome has recently emerged, involving metabolic dysregulation, which implicates adipose tissue, skeletal muscle and the endocrine systems (insulin, leptin, adiponectin) in interacting with the failing heart. Chronic heart failure is associated with increased systemic and myocardial insulin resistance, impaired cardiac energetics, and a spectrum of weight loss (including cachexia) in the more advanced stage. This review will focus on the metabolic adaptations that have been associated with heart failure and focus on the reversible components that have been identifi ed with therapeutic interventions known to achieve a signifi cant degree of reverse myocardial remodeling – β-adrenergic receptor blockade and mechanical unloading with left ventricular assist device support. Heart Metab; 2013;61:8–14