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. Author manuscript; available in PMC: 2017 Apr 1.
Published in final edited form as: Nat Rev Cardiol. 2016 Dec 22;14(4):238–250. doi: 10.1038/nrcardio.2016.203

Table 1.

Bioenergetic changes in human heart failure

Patient characteristics (n) ATP PCr PCr/ATP Notes
NYHA class II (29), class III (8)228 NR NR ↓ Decrease in PCr/ATP ratio in patients with HFpEF
NYHA class I (10), class III (8), class IV (1)229 NR NR ↓ Decrease in PCr/ATP ratio in HCM correlated with presence of fibrotic
areas in myocardium of left ventricle
LVH (20); LVH and CHF (10); no LVH (10)230 ↓ ↓ ↓ Decrease in ATP flux through CK; 30% decrease in PCr/ATP ratio
NYHA class I (1), class II (7), class III (7),
class III–IV (1), class IV (1)231 		↓ ↓ NR —
HCM gene mutations in MHC7 (16), TNNT2 (8),
or MYBPC2 (7) (31)232 		NR NR ↓ 30% reduction in patients with HCM compared with controls; reduction
similar in all groups
HHD (NYHA class 0 [10]) = = ↓

  • No change in ATP in AS or HHD; 35% decrease in ATP in DCM

  • 28% decrease in PCr in AS, 51% in DCM, no change in HHD

  • 25% decrease in PCr/ATP ratio in HHD
AS (NYHA class II [7], class III [3]) = ↓ NR
DCM (NYHA class II [1], class III [9])233 ↓ ↓ NR
AS (10); five followed up234 NR NR ↓ Decrease in PCr/ATP before aortic valve repair
HHD (11)235 NR NR ↓ —
Chronic mitral regurgitation (22)236 NR NR ↓ —
HCM (14)237 NR NR ↓ —
DCM (43 total; 6 restrictive cardiomyopathy, 10
normal systolic and diastolic function; 24 cold
preserved from transplantations)238 		↓ NR NR Decrease in ATP in DCM
AI (9; NYHA class average 2.44) or
AS (13; NYHA class average 2.77)239 		NR NR ↓

  • Significant reduction in PCr/ATP ratio in patients with AS; trend towards a reduction in patients with AI

  • Significant decrease in PCr/ATP ratio for all patients in NYHA class III, but not those in class I or II
DCM (23; NYHA class average 2.7)240 NR NR ↓ —
AS (41)241 ↓ ↓ NR —
Severe AS (27)242 NR NR ↓ Hand-grip strength tests (marker of cardiac health) employed in patients
HCM (19)243 NR NR ↓ —
DCM and CHF (NYHA class I [1], class II [3],
class III [4])244 		NR NR = No change with dobutamine infusion
DCM (9), HCM (8)245 NR NR ↓ Decreased PCr/ATP ratio in HCM, but not DCM
CAD (14), DCM (19 total; NYHA class II [4],
class III [4], class II–III [7], class III–IV [4])246 		NR NR ↓

  • Decreased PCr/ATP ratio in DCM

  • Trend for decreased PCr/ATP ratio in CAD

  • Relationship exists between severity of HF and decrease in PCr/ATP ratio
DCM (19), ICM (11)247 = NR NR

  • No change in ATP levels in DCM biopsies

  • Lower ATP levels in ICM, but not significantly different
Aortic valve disease (6), AI (8)248 NR NR ↓ Decreased PCr/ATP ratio in patients being treated for heart failure
DCM (20)249 NR NR ↓ —
DCM (6), severe LVH (6), mild LVH (5)250 NR NR = No change in PCr/ATP ratio in LVH or DCM

AI, aortic insufficiency; AS, aortic stenosis; CAD, coronary artery disease; CHF, congestive heart failure; CK, creatine kinase; DCM, dilated cardiomyopathy; HCM, hypertrophic cardiomyopathy; HFpEF, heart failure with preserved ejection fraction; HHD; hypertensive heart disease; ICM, insertable cardiac monitor; LVH, left ventricular hypertrophy; NR, not reported; PCr, phosphocreatine.