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Cardiac intermediary metabolism in heart failure: substrate use, signalling roles and therapeutic targets 心力衰竭的心脏中间代谢:底物使用,信号作用和治疗靶点。
IF 44.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-06-22 DOI: 10.1038/s41569-025-01166-7
Mathias Mericskay, Coert J. Zuurbier, Lisa C. Heather, Anja Karlstaedt, Javier Inserte, Luc Bertrand, Georgios Kararigas, Marisol Ruiz-Meana, Christoph Maack, Gabriele G. Schiattarella
The number of patients with heart failure is expected to rise sharply owing to ageing populations, poor dietary habits, unhealthy lifestyles and improved survival rates from conditions such as hypertension and myocardial infarction. Heart failure is classified into two main types: heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). These forms fundamentally differ, especially in how metabolism is regulated, but they also have shared features such as mitochondrial dysfunction. HFrEF is typically driven by neuroendocrine activation and mechanical strain, which demands a higher ATP production to sustain cardiac contraction. However, the primary energy source in a healthy heart (fatty acid β-oxidation) is often suppressed in HFrEF. Although glucose uptake increases in HFrEF, mitochondrial dysfunction disrupts glucose oxidation, and glycolysis and ketone oxidation only partially compensate for this imbalance. Conversely, HFpEF, particularly in individuals with metabolic diseases, such as obesity or type 2 diabetes mellitus, results from both mechanical and metabolic overload. Elevated glucose and lipid levels overwhelm normal metabolic pathways, leading to an accumulation of harmful metabolic byproducts that impair mitochondrial and cellular function. In this Review, we explore how disruptions in cardiac metabolism are not only markers of heart failure but also key drivers of disease progression. We also examine how metabolic intermediates influence signalling pathways that modify proteins and regulate gene expression in the heart. The growing recognition of the role of metabolic alterations in heart failure has led to groundbreaking treatments that target these metabolic disruptions, offering new hope for these patients. In this Review, Mericskay and colleagues discuss the role of cardiac intermediary metabolism in heart failure, describing the perturbations in cardiac energy metabolism that occur in heart failure with reduced ejection fraction and cardiometabolic heart failure with preserved ejection fraction, and highlighting potential treatments to target intermediary metabolism in these patients.
由于人口老龄化、不良的饮食习惯、不健康的生活方式以及高血压和心肌梗塞等疾病的存活率提高,心力衰竭患者的数量预计将急剧增加。心力衰竭主要分为两种类型:心力衰竭伴射血分数降低(HFrEF)和心力衰竭伴射血分数保持(HFpEF)。这些形式在本质上是不同的,尤其是在新陈代谢的调节方式上,但它们也有共同的特征,比如线粒体功能障碍。HFrEF通常由神经内分泌激活和机械应变驱动,这需要更高的ATP生成来维持心脏收缩。然而,健康心脏的主要能量来源(脂肪酸β-氧化)在HFrEF中经常被抑制。虽然HFrEF中葡萄糖摄取增加,但线粒体功能障碍会破坏葡萄糖氧化,糖酵解和酮氧化只能部分补偿这种不平衡。相反,HFpEF,特别是在患有代谢性疾病(如肥胖或2型糖尿病)的个体中,是机械和代谢超负荷的结果。葡萄糖和脂质水平升高会破坏正常的代谢途径,导致有害代谢副产物的积累,损害线粒体和细胞功能。在这篇综述中,我们探讨了心脏代谢紊乱不仅是心力衰竭的标志,也是疾病进展的关键驱动因素。我们还研究了代谢中间体如何影响改变蛋白质和调节心脏基因表达的信号通路。越来越多的人认识到代谢改变在心力衰竭中的作用,这导致了针对这些代谢紊乱的突破性治疗,为这些患者带来了新的希望。
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引用次数: 0
Metabolic alterations in heart failure 心力衰竭的代谢改变
IF 44.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-06-22 DOI: 10.1038/s41569-025-01181-8
Christoph Maack
Metabolic diseases are important risk factors for the development of heart failure, and energetic deficit and oxidative stress are important in its pathophysiology. A Focus issue in Nature Reviews Cardiology appraises the metabolic alterations in heart failure, with an emphasis on substrate and intermediate metabolism, vascular dysfunction, inflammation and mechano-energetic uncoupling, integrating these different pathomechanistic angles into one cohesive view.
代谢性疾病是心衰发生的重要危险因素,能量不足和氧化应激在心衰的病理生理中起重要作用。Nature Reviews Cardiology的一个焦点问题评估了心力衰竭的代谢改变,重点是底物和中间代谢,血管功能障碍,炎症和机械-能量解耦,将这些不同的病理机制角度整合到一个有凝聚力的观点中。
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引用次数: 0
Immunometabolism in heart failure 心力衰竭的免疫代谢
IF 44.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-06-22 DOI: 10.1038/s41569-025-01165-8
Ioanna Andreadou, Alessandra Ghigo, Panagiota-Efstathia Nikolaou, Filip K. Swirski, James T. Thackeray, Gerd Heusch, Gemma Vilahur
The interaction between inflammation and metabolism (immunometabolism) is a crucial factor in the pathophysiology of heart failure, whether the cardiac failure originates from ischaemic injury or systemic metabolic disorders, and whether it is associated with reduced or preserved ejection fraction. Ischaemia, metabolic stress and comorbidity-driven systemic inflammation attract innate and adaptive immune cells to the myocardium and induce their polarization towards pro-inflammatory or anti-inflammatory phenotypes through cell-intrinsic metabolic shifts involving oxidative phosphorylation and anaerobic glycolysis. These infiltrating immune cells modulate cardiac and systemic metabolism. The bidirectional metabolic crosstalk between immune cells and parenchymal and stromal cardiac cells contributes to adverse cardiac remodelling. In turn, ischaemic injury and deregulated metabolism stimulate bone marrow and extramedullary myelopoiesis, which increases immune cell recruitment and perpetuates a non-resolving chronic inflammatory state. Pharmacological interventions targeting metabolism have shown promise for improving outcomes in patients with heart failure, but immunomodulatory approaches face multiple challenges. Understanding the complex metabolic pathways and cell–cell interactions that regulate immunometabolism in heart failure is essential to identify new therapies that shift the balance from maladaptive to cardioprotective immune responses. In this Review, we provide a comprehensive overview of the intricate cellular and molecular mechanisms that govern immunometabolism in heart failure and discuss potential approaches to non-invasively monitor and treat patients with heart failure. In this Review, the authors discuss the cellular and molecular mechanisms of immunometabolism in heart failure and highlight potential approaches for non-invasive monitoring and for the treatment of patients with heart failure.
炎症与代谢(免疫代谢)之间的相互作用是心衰病理生理的关键因素,无论心衰源于缺血性损伤还是全身性代谢紊乱,以及是否与射血分数降低或保留有关。缺血、代谢应激和共病驱动的全身性炎症将先天和适应性免疫细胞吸引到心肌,并通过细胞内在代谢变化(包括氧化磷酸化和厌氧糖酵解)诱导其向促炎或抗炎表型分化。这些浸润性免疫细胞调节心脏和全身代谢。免疫细胞与心肌实质细胞和间质细胞之间的双向代谢串扰有助于心脏不良重构。反过来,缺血性损伤和代谢失调刺激骨髓和髓外骨髓生成,从而增加免疫细胞募集并使慢性炎症状态持续存在。针对代谢的药物干预已显示出改善心力衰竭患者预后的希望,但免疫调节方法面临多重挑战。了解心脏衰竭中调节免疫代谢的复杂代谢途径和细胞-细胞相互作用,对于确定将平衡从适应不良转变为心脏保护免疫反应的新疗法至关重要。在这篇综述中,我们全面概述了控制心力衰竭免疫代谢的复杂细胞和分子机制,并讨论了无创监测和治疗心力衰竭患者的潜在方法。
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引用次数: 0
Vascular (dys)function in the failing heart 衰竭心脏的血管功能。
IF 44.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-06-22 DOI: 10.1038/s41569-025-01163-w
Luca Liberale, Dirk Jan Duncker, Derek John Hausenloy, Simon Kraler, Hans Erik Bøtker, Bruno Karl Podesser, Gerd Heusch, Petra Kleinbongard
Heart failure (HF) is not confined to contractile failure of cardiomyocytes or myocardial fibrosis. Coronary and systemic vascular dysfunction contributes to the initiation and progression of HF with or without reduced ejection fraction. Furthermore, HF compromises vascular function, creating and sustaining a vicious cycle with deranging effects on coronary blood flow, cardiac metabolism and cardiac function. In HF, systemic arterial dysfunction, characterized by increased arterial stiffness and resistance, raises cardiac afterload and impedes myocardial contractile function. Reduced coronary blood flow impairs myocardial oxygen delivery and consequently cardiomyocyte metabolism and function. Coronary microvascular dysfunction is heterogeneous in its pathogenesis and manifestations, complicating the diagnosis and management across different HF phenotypes. Understanding the alterations in function in different segments of the vasculature, from the aorta to the capillary level, offers mechanistic insights into disease drivers and therapeutic interventions. Interventional approaches can improve vascular haemodynamics, whereas established and emerging pharmacotherapies target the neurohumoral axis and reduce extravascular compression, inflammation, and oxidative stress, thereby improving vascular function and HF-related outcomes. In this Review, we provide a mechanistic framework of vascular dysfunction in the pathogenesis of HF with or without reduced ejection fraction, pointing towards integrated therapies that consider the vascular implications of contemporary HF management across HF phenotypes. Coronary and systemic vascular dysfunction contributes to the initiation and progression of heart failure (HF) with or without reduced ejection fraction and, vice versa, HF compromises vascular function. In this Review, Liberale and colleagues discuss vascular dysfunction in the pathogenesis of HF and how pharmacological, interventional and surgical management of HF can improve vascular function.
心力衰竭(HF)并不局限于心肌细胞的收缩性衰竭或心肌纤维化。无论射血分数是否降低,冠状动脉和全身血管功能障碍都有助于HF的发生和发展。此外,心衰损害血管功能,形成并维持恶性循环,对冠状动脉血流、心脏代谢和心脏功能产生紊乱影响。在心力衰竭中,全身动脉功能障碍,以动脉僵硬和阻力增加为特征,增加心脏后负荷并阻碍心肌收缩功能。冠状动脉血流量减少会损害心肌氧输送,从而影响心肌细胞的代谢和功能。冠状动脉微血管功能障碍的发病机制和表现具有异质性,使不同HF表型的诊断和治疗复杂化。了解从主动脉到毛细血管水平的不同血管段功能的改变,为疾病驱动和治疗干预提供了机制上的见解。介入治疗可以改善血管血流动力学,而现有的和新兴的药物治疗针对神经体液轴,减少血管外压迫、炎症和氧化应激,从而改善血管功能和hf相关的结果。在这篇综述中,我们提供了一个关于有或没有射血分数降低的HF发病机制中的血管功能障碍的机制框架,指出了考虑到当代HF管理在HF表型中的血管意义的综合治疗。
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引用次数: 0
Atheroprotection mediated by hepatic PPARα is linked to its anti-inflammatory, but not lipid-lowering, properties 肝PPARα介导的动脉粥样硬化保护与其抗炎而非降脂特性有关
IF 44.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-06-12 DOI: 10.1038/s41569-025-01182-7
Karina Huynh
A new study in science Translational Medicine demonstrates that the atheroprotective effects of PPARα agonists are associated with their anti-inflammatory properties rather than their lipid-lowering activity, highlighting the importance of targeting inflammation in managing the residual risk of cardiovascular disease
《科学转化医学》的一项新研究表明,PPARα激动剂的动脉粥样硬化保护作用与其抗炎特性有关,而不是其降脂活性,强调了靶向炎症在控制心血管疾病残留风险中的重要性
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引用次数: 0
Leadless and extravascular cardiac resynchronization therapy: the future for CRT? 无铅和血管外心脏再同步化治疗:CRT的未来?
IF 44.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-06-06 DOI: 10.1038/s41569-025-01178-3
Steven Niederer, Henry Chubb, Kenneth C. Bilchick, Christopher Aldo Rinaldi
Cardiac resynchronization therapy is used to treat dyssynchronous heart failure. Lead-related complications and anatomical constraints can limit pacing lead placement, but leadless systems are now becoming available. These new systems overcome lead-related issues, offering a new option for patients with complex disease (such as congenital heart disease) by eliminating intravascular hardware.
心脏再同步化治疗用于治疗非同步心衰。导线相关的并发症和解剖限制可能会限制起搏导线的放置,但无导线系统现在已经可用。这些新系统克服了与铅有关的问题,通过消除血管内硬件,为患有复杂疾病(如先天性心脏病)的患者提供了新的选择。
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引用次数: 0
Cardiovascular involvement in glycogen storage diseases 糖原储存病与心血管的关系
IF 44.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-06-05 DOI: 10.1038/s41569-025-01171-w
Tomàs Pinós, Richard M. Cubbon, Alfredo Santalla, Carmen Fiuza-Luces, Alejandro Santos-Lozano, Miguel A. Martín, Joaquín Arenas, Joachim Nielsen, Niels Ørtenblad, Alejandro Lucia
Glycogen storage diseases are rare conditions affecting both sexes that are caused by inherited deficiencies of enzymes involved either in glycogen synthesis or breakdown, or in glycolysis. The liver and skeletal muscle are usually the most affected tissues. However, because glycogen has an important role in cardiac development and function, several glycogen storage diseases are associated, at least indirectly, with cardiac disorders, some of which have severe consequences from the first months of life. Early identification of these conditions is, therefore, an important issue, and implementation of strategies to prevent fatal outcomes due to cardiovascular disease is vital. In this Review, we discuss the pathophysiological mechanisms and the preclinical, clinical and epidemiological evidence for cardiovascular involvement in various glycogen storage diseases. We also describe interventions that can help preserve heart function, including changes in nutrition and exercise, as well as the few available molecular therapies to address the underlying metabolic anomalies. Glycogen has an important role in cardiac development and function. In this Review, Pinós and colleagues discuss the cardiovascular manifestations of glycogen storage diseases caused by rare inherited deficiencies of enzymes involved either in glycogen synthesis or breakdown, or in glycolysis. Interventions, including gene therapies, for these conditions are also summarized.
糖原贮藏病是一种罕见的男女皆患的疾病,它是由遗传性的糖原合成、分解或糖酵解酶缺乏引起的。肝脏和骨骼肌通常是最受影响的组织。然而,由于糖原在心脏发育和功能中起着重要作用,一些糖原蓄积性疾病至少间接与心脏疾病相关,其中一些从出生后的头几个月就有严重的后果。因此,及早发现这些疾病是一个重要问题,实施预防心血管疾病致命后果的战略至关重要。在这篇综述中,我们讨论了各种糖原储存疾病的病理生理机制以及心血管参与的临床前、临床和流行病学证据。我们还描述了可以帮助保持心脏功能的干预措施,包括营养和运动的改变,以及少数可用的分子疗法来解决潜在的代谢异常。
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引用次数: 0
Think Aorta: aortic dissection awareness and perspectives from the patient 思考主动脉:患者对主动脉夹层的认识和观点
IF 44.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-06-03 DOI: 10.1038/s41569-025-01177-4
Gareth Owens
Aortic dissection has long been considered a rare, unpreventable and inevitably fatal disease. However, recent advances now prove otherwise. The patient-led Think Aorta campaign is challenging old thinking, improving diagnosis and advocating for better care, such as family screening. Patient advocacy and recent international guidelines classifying the aorta as an organ are catalysts for further improvements in patient care.
主动脉夹层一直被认为是一种罕见的、不可预防的、不可避免的致命疾病。然而,最近的进展证明并非如此。由患者主导的“思考主动脉”运动正在挑战旧思维,提高诊断水平,倡导更好的护理,比如家庭筛查。患者倡导和最近的国际指南分类主动脉作为一个器官是催化剂,进一步改善患者护理。
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引用次数: 0
Networking effectively with cardiovascular societies: strategies for meaningful engagement and career advancement 有效地与心血管协会建立联系:有意义的参与和职业发展的策略
IF 44.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-05-29 DOI: 10.1038/s41569-025-01174-7
Purvi Parwani, F. Aaysha Cader
Effective engagement with cardiovascular societies enhances professional development, academic growth and leadership opportunities. We describe practical strategies for cardiovascular professionals to connect with their peers, seek mentorship, advance professionally and contribute as active members of the cardiovascular society, to develop an impactful career and advance the field of cardiac medicine.
有效参与心血管学会促进专业发展,学术成长和领导的机会。我们为心血管专业人士提供实用的策略,帮助他们与同行联系,寻求指导,在专业上取得进步,并作为心血管社会的积极成员做出贡献,从而发展有影响力的职业生涯,推动心脏医学领域的发展。
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引用次数: 0
Reply to ‘Neuroendocrine regulatory effects of sex hormones on salt sensitivity of blood pressure’ 回复“性激素对血压盐敏感性的神经内分泌调节作用”
IF 44.2 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-05-28 DOI: 10.1038/s41569-025-01176-5
Sepiso K. Masenga, Annet Kirabo
{"title":"Reply to ‘Neuroendocrine regulatory effects of sex hormones on salt sensitivity of blood pressure’","authors":"Sepiso K. Masenga, Annet Kirabo","doi":"10.1038/s41569-025-01176-5","DOIUrl":"10.1038/s41569-025-01176-5","url":null,"abstract":"","PeriodicalId":18976,"journal":{"name":"Nature Reviews Cardiology","volume":"22 9","pages":"690-691"},"PeriodicalIF":44.2,"publicationDate":"2025-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Nature Reviews Cardiology
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