Published in:
Open Access
07-10-2021 | Heart Failure
Creatine deficiency and heart failure
Authors:
Annamaria Del Franco, Giuseppe Ambrosio, Laura Baroncelli, Tommaso Pizzorusso, Andrea Barison, Iacopo Olivotto, Fabio A. Recchia, Carlo M. Lombardi, Marco Metra, Yu F. Ferrari Chen, Claudio Passino, Michele Emdin, Giuseppe Vergaro
Published in:
Heart Failure Reviews
|
Issue 5/2022
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Abstract
Impaired cardiac energy metabolism has been proposed as a mechanism common to different heart failure aetiologies. The energy-depletion hypothesis was pursued by several researchers, and is still a topic of considerable interest. Unlike most organs, in the heart, the creatine kinase system represents a major component of the metabolic machinery, as it functions as an energy shuttle between mitochondria and cytosol. In heart failure, the decrease in creatine level anticipates the reduction in adenosine triphosphate, and the degree of myocardial phosphocreatine/adenosine triphosphate ratio reduction correlates with disease severity, contractile dysfunction, and myocardial structural remodelling. However, it remains to be elucidated whether an impairment of phosphocreatine buffer activity contributes to the pathophysiology of heart failure and whether correcting this energy deficit might prove beneficial. The effects of creatine deficiency and the potential utility of creatine supplementation have been investigated in experimental and clinical models, showing controversial findings. The goal of this article is to provide a comprehensive overview on the role of creatine in cardiac energy metabolism, the assessment and clinical value of creatine deficiency in heart failure, and the possible options for the specific metabolic therapy.