A simple question, yet one that is of great practical importance, is whether the failing heart is
in an energy-starved state. Knowledge of the energetics of the failing heart would, for
example, help clinicians to decide whether increasing myocardial energy expenditure using
positive inotropic drugs is indicated in the management of this chronic condition or whether
treatment of these patients should include negative inotropic drugs to reduce energy
demands. As it is now clear that improving long-term prognosis is a major goal in the …