Cardiac Substrate Utilization and Relationship to Invasive Exercise Hemodynamic Parameters in HFpEF

John F O'Sullivan; Mengbo Li; Yen Chin Koay; Xiao Suo Wang; Giovanni Guglielmi; Francine Z Marques; Shane Nanayakkara; Justin Mariani; Eugene Slaughter; David M Kaye

doi:10.1016/j.jacbts.2023.11.006

Cardiac Substrate Utilization and Relationship to Invasive Exercise Hemodynamic Parameters in HFpEF

JACC Basic Transl Sci. 2024 Jan 31;9(3):281-299. doi: 10.1016/j.jacbts.2023.11.006. eCollection 2024 Mar.

Authors

John F O'Sullivan^{1

2

3

4}, Mengbo Li^{5

6}, Yen Chin Koay^{1

3}, Xiao Suo Wang¹, Giovanni Guglielmi^{7

8}, Francine Z Marques^{9

10

11

12}, Shane Nanayakkara^{10

12

13}, Justin Mariani^{11

12

13}, Eugene Slaughter¹, David M Kaye^{10

12

13}

Affiliations

¹ Cardiometabolic Medicine, School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia.
² Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia.
³ Charles Perkins Centre, The University of Sydney, Camperdown, Australia.
⁴ Department of Medicine, TU Dresden, Dresden, Germany.
⁵ Bioinformatics Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia.
⁶ Department of Medical Biology, The University of Melbourne, Parkville, Victoria, Australia.
⁷ Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia.
⁸ School of Mathematics, University of Birmingham, Birmingham, United Kingdom.
⁹ Hypertension Research Laboratory, School of Biological Sciences, Faculty of Science, Monash University, Melbourne, Australia.
¹⁰ Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia.
¹¹ Victorian Heart Institute, Monash University, Melbourne, Australia.
¹² Department of Cardiology, Alfred Hospital, Melbourne, Australia.
¹³ Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia.

Abstract

The authors conducted transcardiac blood sampling in healthy subjects and subjects with heart failure with preserved ejection fraction (HFpEF) to compare cardiac metabolite and lipid substrate use. We demonstrate that fatty acids are less used by HFpEF hearts and that lipid extraction is influenced by hemodynamic factors including pulmonary pressures and cardiac index. The release of many products of protein catabolism is apparent in HFpEF compared to healthy myocardium. In subgroup analyses, differences in energy substrate use between female and male hearts were identified.

Keywords: cardiac energetics; heart failure with preserved ejection fraction; invasive hemodynamics; lipids.