Ketone bodies in treatment of heart failure – A novel concept

Ketone bodies in treatment of heart failure – A novel concept

Ketone bodies in treatment of heart failure: The failing heart reduces fatty acid and glucose oxidation and increases ketone metabolism [1].

Roni Nielsen, Niels Møller, Lars C Gormsen, Lars Poulsen Tolbod, Nils Henrik Hansson, Jens Sorensen, Hendrik Johannes Harms, Jørgen Frøkiær, Hans Eiskjaer, Nichlas Riise Jespersen, Søren Mellemkjaer, Thomas Ravn Lassen, Kasper Pryds, Hans Erik Bøtker and Henrik Wiggers assessed the role of exogenously administered ketones in heart failure [2]. They gave a three hour 3-hydroxybutyrate infusion to 16 patients with chronic heart failure with reduced ejection fraction. It was a randomized crossover design with placebo infusion as well. The left ventricular ejection fraction was 37±3% at baseline. Cardiac output rose by 2.0±0.2 L/min ( P<0.001) with a corresponding increase in stroke volume of 20±2 mL ( P<0.001). Heart rate also rose 7±2 beats per minute (bpm) ( P<0.001). Left ventricular ejection fraction also increased 8±1% ( P<0.001). In another arm of the study they also demonstrated a dose response relationship with increased oxygen consumption (MVO2), but without altering myocardial external energy efficiency (MEE).

Use of ketone body 3-Hydroxybutyrate in chronic heart failure might become a novel principle in the treatment of heart failure if future large scale studies fine tune its use.

Reference

1. Senthil Selvaraj, Daniel P Kelly, Kenneth B Margulies. Implications of Altered Ketone Metabolism and Therapeutic Ketosis in Heart Failure. Circulation. 2020 Jun 2;141(22):1800-1812.
2. Roni Nielsen, Niels Møller, Lars C Gormsen, Lars Poulsen Tolbod, Nils Henrik Hansson, Jens Sorensen, Hendrik Johannes Harms, Jørgen Frøkiær, Hans Eiskjaer, Nichlas Riise Jespersen, Søren Mellemkjaer, Thomas Ravn Lassen, Kasper Pryds, Hans Erik Bøtker. Henrik Wiggers. Cardiovascular Effects of Treatment With the Ketone Body 3-Hydroxybutyrate in Chronic Heart Failure Patients. Circulation. 2019 Apr 30;139(18):2129-2141.