dysfunction in Cardiac Metabolism  in heart failure is a highly prevalent condition in patients affected by heart failure; however, it is still unclear whether, in the setting of cardiac dysfunction, it represents an adverse risk factor for the occurrence of cardiac events.

Insulin resistance, hyperglycaemia, and diabetes mellitus Several studies indicate that diabetes mellitus and IR are not only causative factors of HF,6,7 but patients with HF and DM or IR also have a more aggressive form of left ventricular dysfunction with higher mortality rates than those without HF and DM or IR.8 Insulin resistance is highly prevalent in patients affected by HF,9 and a complex pathophysiological interaction exists between these two conditions, since IR may represent, at the same time, cause and consequence of HF. Similarly,  DM is common in HF patients with a prevalence that ranges from 10 to 30% up to 40% in hospitalized patients.

15,16 HF patients with DM or without DM but with IR show more impaired cardiac sympathetic innervation, Compared with patients without diabetes and without IR, it shows chronic hyperadrenergic hyperactivity related to HbA1c levels and IR index9,17 We recently reported that levels of GRK2, a protein kinase involved in the desensitization of cardiac beta-receptors, are significantly more elevated in HF patients with DM compared with non-diabetic HF patients.

The favourable association of obesity and HF is not simply the result of poorer outcomes in patients with severe HF and cardiac cachexia, as patients with high BMI, whether overweight or obese,  show lower mortality rates than patients with normal BMI and those who are underweight.

The presence of a condition that counterbalances the effects of inflammation and protein malnutrition, as overweight or moderate obesity, may be beneficial in patients affected by HF. However, it is less clear whether intentional changes of BMI in patients with HF, either weight gain or weight loss, are associated with CV risk modification.

cardiac Metabolic syndrome is highly prevalent in patients with HF and is associated with multiple molecular, cellular, and neurohormonal responses that may affect prognosis.

Heart failure is associated with cardiac metabolic changes that cause a progressive impairment of cardiac and skeletal muscle high-energy phosphate production..

Efficacy of Metabolic Modulation in HF. The beneficial effect of metabolic modulation of cardiac metabolism in HF has been attributed to the shift of energy production from free fatty acid oxidation to glucose oxidation, which leads to increased production of high-energy phosphates and therefore to greater cardiac and skeletal muscle efficiency.

Several clinical trials have demonstrated that metabolic modulation through inhibition of free fatty acid metabolism improves New York Heart Association HF class, exercise tolerance, quality of life, left ventricular ejection fracture and cardiac volumes in patients with ischaemic and non-ischaemic HF.

Cardiac metabolism in Heart failure is associated with maladaptive cardiac metabolism.

Cardiac metabolism in heart failure is shifted towards the use of less energy-efficient free fatty acids.

Modulation of cardiac metabolism in heart failure improves left ventricular function and exercise capacity in heart failure.

Optimization of cardiac metabolism in heart failure.

The duration of compensation can be extremely variable and depends on the cause of your heart failure and whether you have other medical problems.