Metabolic remodelling in heart failure revisited

The Review by Edoardo Bertero and Christoph Maack (Metabolic remodelling in heart failure. Nat. Rev. Cardiol. 15, 457–470; 2018) addresses the changes in cardiac energy metabolism that occur during the development of heart failure (HF). The authors convincingly argue that alterations
of intermediate substrate metabolism and oxidative stress, rather than an ATP deficit per se, account for maladaptive remodelling and dysfunction. Despite the comprehensive discussion of this topic, some aspects need further clarification or elaboration.