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Over the past decades, a clear relationship has been established between poor cardiac performance and metabolic perturbations, including deficits in substrate uptake and utilization, reduction in mitochondrial oxidative phosphorylation and excessive reactive oxygen species production. Together, these perturbations result in progressive depletion of cardiac adenosine triphosphate (ATP) and cardiac energy deprivation. Increasing the delivery of energy substrates (e.g., fatty acids, glucose, ketones) to the mitochondria will be worthless if the mitochondria are unable to turn these energy substrates into fuel. Micronutrients (including coenzyme Q10, zinc, copper, selenium and iron) are required to efficiently convert macronutrients to ATP. However, up to 50% of patients with heart failure are deficient in one or more micronutrients in cross\u2010sectional studies. Micronutrient deficiency has a high impact on mitochondrial energy production and should be considered an additional factor in the heart failure equation, moving our view of the failing myocardium away from an \u201can engine out of fuel\u201d to \u201ca defective engine on a path to self\u2010destruction.\u201d This summary of evidence suggests that supplementation with micronutrients\u2014preferably as a package rather than singly\u2014might be a potential therapeutic strategy in the treatment of heart failure patients.<\/jats:p>","DOI":"10.1111\/joim.13456","type":"journal-article","created":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T03:38:41Z","timestamp":1644377921000},"page":"713-731","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Micronutrient deficiencies in heart failure: Mitochondrial dysfunction as a common pathophysiological mechanism?"],"prefix":"10.1111","volume":"291","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5926-6960","authenticated-orcid":false,"given":"Nils","family":"Bomer","sequence":"first","affiliation":[{"name":"Department of Cardiology University Medical Center Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3330-9384","authenticated-orcid":false,"given":"Mario G.","family":"Pavez\u2010Giani","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Medical Center Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niels","family":"Grote Beverborg","sequence":"additional","affiliation":[{"name":"Department of Cardiology University Medical Center Groningen  Groningen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G. 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