The present findings arising from this “snapshot” of severe end-stage heart failure indicate that the increased PDH activity is contributing to the final stage of adaptive survival in a setting of diminished processes that include decreased activity rates of complex I, complex IV, nicotinamide nucleotide transhydrogenase, isocitrate dehydrogenase, malate dehydrogenase, and aconitase; decreased cellular levels of total glutathione and coenzyme Q10; and augmented postoxidative modifications to metabolic and myofilament proteins, as we previously reported for this cohort [4, 5, 8]. Here, NNT is linked to heart failure.