Evolving Concepts of Myocardial Energy Metabolism More Than Just Fats and Carbohydrates

Although mitochondrial fatty acid and carbohydrate oxidation are the major source of ATP production in the heart, it is becoming increasingly clear that oxidation of other energy substrates, such as ketones and branched chain amino acids (BCAAs), can also contribute to energy production. Of importance is that alterations in cardiac ketone and branched chain amino acids metabolism may also impact the severity of heart failure through alterations in cellular signaling, despite these fuels providing a lower contribution to overall energy production.