No low-fat diet for the failing heart?
No low-fat diet for the failing heart?
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心脏衰竭时没有低脂饮食吗？
DOI：
10.1161/circulationaha.106.659235
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发表时间：
2006
期刊：
影响因子：
37.8
通讯作者：
Ballal,Kalpana
中科院分区：
文献类型：
--
作者：
Taegtmeyer,Heinrich;Ballal,Kalpana
很可能每个人都知道心脏的氧气需求，但很少有人会认为心脏的能量提供基质的代谢是一个大问题。自C. Lovatt Evans和Ernest Starling 1，2在上个世纪初，生理学家已经认识到心脏是一种有效的能量转换器。就像发动机一样，心脏将化学能高效地转化为机械能。提供能量的底物的代谢和心脏的收缩是紧密耦合的。3因为心脏收缩的能量来源于二磷酸腺苷氧化磷酸化为三磷酸腺苷，心肌耗氧量也常用于测量心脏效率。4心脏的另一个特征也值得一提。心脏是一种代谢杂食动物，对于任何给定的环境，它都使用最经济的燃料。在禁食状态下，当脂肪酸水平高时，心脏主要氧化脂肪酸。6.当心脏受到压力并转向碳水化合物氧化时，代谢适应性开始发挥作用。随着工作负荷的短期增加，离体工作的心脏通过糖原、乳酸盐和葡萄糖的氧化来满足其增加的能量需求。4.对于一定量的氧气，体内心脏使用葡萄糖比使用脂肪酸作为主要能量提供基质的效率高40%。7.在模拟运动状态下，心脏几乎只消耗糖原和氧化乳酸。8随着工作负荷的长期变化，广泛的代谢重塑伴随着心脏肥大、萎缩和心力衰竭过程中的结构和功能变化，这种重塑包括胎儿代谢基因程序的重新激活。9，10胎儿心脏能量底物代谢的一个标志是它依赖碳水化合物（特别是乳酸盐）进行能量转换。然而，与胎儿心脏相比，其糖原储备丰富，衰竭的心脏具有耗尽的代谢能量储备。衰竭的心脏由于缺乏内源性能量储备而依赖于外源性底物提供能量。
Chances are that everyone knows about the heart’s oxygen requirement, but few would consider the heart’s metabolism of energy-providing substrates a big issue. Since the celebrated work of C. Lovatt Evans and Ernest Starling1, 2 at the beginning of the last century, physiologists have recognized the heart as an efficient transducer of energy. Like an engine, the heart turns chemical energy into mechanical energy, efficiently and at a high rate. Metabolism of energy-providing substrates and contractions of the heart are tightly coupled. 3 Because the heart’s energy for contraction is derived from oxidative phosphorylation of adenosine diphosphate to adenosine triphosphate, myocardial oxygen consumption is also commonly used to measure cardiac efficiency. 4 Another feature of the heart is also worth mentioning. The heart is a metabolic omnivore, and for any given environment it uses the most economic fuel available5 (Figure). In the fasted state, when the fatty acid levels are high, the heart oxidizes predominantly fatty acids. 6 Metabolic adaptability comes into play when the heart is stressed and veers toward carbohydrate oxidation. With a short-term increase in workload, the working heart ex vivo covers its increased need for energy through the oxidation of glycogen, lactate, and glucose, in that order. 4 For a given amount of oxygen used, the heart in vivo performs up to 40% more efficiently with glucose than with fatty acids as the main energy-providing substrate. 7 In a simulated state of exercise, the heart spares glycogen and oxidizes lactate almost exclusively. 8 With long-term changes in workload, extensive metabolic remodeling accompanies the structural and functional changes of the heart in the course of hypertrophy, atrophy, and heart failure, and this remodeling includes a reactivation of the fetal metabolic gene program. 9, 10 A hallmark of energy substrate metabolism of the fetal heart is its reliance on carbohydrates (especially lactate) for energy conversion. In contrast to the fetal heart, however, with its abundant glycogen reserves, 11 the failing heart has a depleted metabolic energy reserve. The failing heart relies on exogenous substrate for energy provision because of the lack of endogenous energy reserves.
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DOI：
10.1152/ajpheart.2000.279.4.h1490
发表时间：
2000-10-01
影响因子：
4.8
作者：
Goodwin, GW;Taegtmeyer, H
通讯作者：
Taegtmeyer, H
心脏中的糖原——扩展视图。
影响因子：
5
作者：
H. Taegtmeyer
通讯作者：
H. Taegtmeyer
影响因子：
7.7
作者：
Santomauro, ATMG;Boden, G;Wajchenberg, BL
通讯作者：
Wajchenberg, BL
影响因子：
15.9
作者：
STEINBERG, HO;BRECHTEL, G;BARON, AD
通讯作者：
BARON, AD
影响因子：
4.8
作者：
Goodwin, GW;Taylor, CS;Taegtmeyer, H
通讯作者：
Taegtmeyer, H