Chronic heart failure (CHF) with reduced left ventricular ejection fraction (LVEF) is associated with remodeling of cardiac energy metabolism; however, experimental data from human hearts that are still in early stages of contractile decline are very sparse. In the current study, we probed the association between LV contractility and myocardial capacity for fatty acid and carbohydrate oxidation in patients having normal-to-mildly decreased systolic function. In patients undergoing coronary artery bypass grafting surgery (n=40, EF ≥40%), a sample of left ventricular myocardium was obtained by subepicardial needle biopsy. Mitochondrial respiratory capacity, as well as oxidation of individual fatty acid and carbohydrate substrates (palmitoyl-carnitine and pyruvate, respectively), were assessed by measuring the rate of oxygen consumption. Also, expression of key mitochondrial metabolic factors and tissue accumulation of ceramide were evaluated, and correlation analysis was performed. Maximal mitochondrial respiration, and expression of mitochondrial biogenesis and remodeling factors (PGC-1α and mitofusin-2) were positively correlated with LVEF (r=0.37-0.50; P<0.05). Although there was no relationship between LVEF and respiration driven by individual metabolic substrates, LVEF was positively correlated with expression of key β-oxidation enzymes. Finally, LVEF was inversely correlated with accumulation of cardiotoxic ceramide (r=0.89, P<0.05). In patients with coronary artery disease exhibiting normal-to-mildly decreased LVEF, cardiac systolic function is associated with mitochondrial respiratory capacity and levels of fatty acid oxidation enzymes, pointing to them as factors involved in early phases of myocardial pathological remodeling.