Both heart failure with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF) are associated with high morbidity and mortality. Although many established pharmacological interventions exist for HFrEF, hospitalization and death rates remain high, and for those with HFpEF (approximately half of all heart failure patients), there are no effective therapies. Recently, the role of impaired cardiac energetic status in heart failure has gained increasing recognition with the identification of reduced capacity for both fatty acid and carbohydrate oxidation, impaired function of the electron transport chain, reduced capacity to transfer ATP to the cytosol, and inefficient utilization of the energy produced. These nodes in the genesis of cardiac energetic impairment provide potential therapeutic targets, and there is promising data from recent experimental and early-phase clinical studies evaluating modulators such as carnitine palmitoyltransferase 1 inhibitors, partial fatty acid oxidation inhibitors and mitochondrial-targeted antioxidants. Metabolic modulation may provide significant symptomatic and prognostic benefit for patients suffering from heart failure above and beyond guideline-directed therapy, but further clinical trials are needed.

射血分数降低（HFrEF）和射血分数保留（HFpEF）的心力衰竭都与高发病率和死亡率相关。尽管 HFrEF 存在许多成熟的药物干预措施，但住院率和死亡率仍然很高，对于 HFpEF 患者（约占所有心力​​衰竭患者的一半），没有有效的治疗方法。最近，随着脂肪酸和碳水化合物氧化能力降低、电子传递链功能受损、将 ATP 转移到胞质溶胶的能力降低以及利用效率低下，心脏能量状态受损在心力衰竭中的作用得到了越来越多的认可。所产生的能量。这些心脏能量损伤发生的节点提供了潜在的治疗靶点，最近的实验和早期临床研究提供了有希望的数据，这些研究评估了肉碱棕榈酰转移酶 1 抑制剂、部分脂肪酸氧化抑制剂和线粒体靶向抗氧化剂等调节剂。代谢调节可以为患有心力衰竭的患者提供超出指南指导治疗的显着症状和预后益处，但需要进一步的临床试验。