Heart failure (HF) is a clinical syndrome characterized by the inability of the heart to provide adequate perfusion to tissues and organs, resulting in typical symptoms such as fatigue, dyspnea, dyspepsia, or swelling due to decreased cardiac output. With its increasing prevalence, heart failure has become one of the leading causes of morbidity and mortality worldwide, imposing a significant burden on the population by reducing long-term life expectancy and raising hospital costs. Indeed, over 20 million people worldwide suffer from heart failure, with a 5-year mortality rate of 60-70%. As heart failure progresses, various structural and metabolic changes occur within the myocardium and organ systems. In the past two decades, therapeutic options for heart failure patients have significantly expanded. In addition to novel pharmacological treatment, advanced surgical methods such as heart transplantation (HTx) and the implantation of durable left ventricular assist devices (LVADs) are available for patients with end-stage heart failure. This review discusses the pathophysiological aspects and metabolic consequences of heart failure and metabolic changes, as well as the benefits and challenges of implanting a left ventricular assist device. Furthermore, future targets for heart failure diagnostics and therapy will be highlighted.

1st Faculty of Medicine Charles University Prague 121 08 Prague Czech Republic

1st Faculty of Medicine Institute of Medical Biochemistry and Laboratory Diagnostics Charles University 128 08 Prague Czech Republic

2nd Department of Surgery Department of Cardiovascular Surgery 1st Faculty of Medicine Charles University 150 06 Prague Czech Republic

Department of Anesthesia and Resuscitation Institute for Clinical and Experimental Medicine 140 21 Prague Czech Republic

Department of Cardiovascular Surgery Institute for Clinical and Experimental Medicine 140 21 Prague Czech Republic

Department of Diabetes Institute for Clinical and Experimental Medicine 140 21 Prague Czech Republic

Department of Physiology 3rd Faculty of Medicine Charles University 100 00 Prague Czech Republic

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