Heart failure & cardiomyopathiesRandomised controlled trial
Randomized Crossover Trial of 2-Week Ketone Ester Treatment in Patients With Type 2 Diabetes and Heart Failure With Preserved Ejection Fraction
- Randomised controlled trial
- double-blind
- crossover
Authors' conclusion
In patients with T2D and HFpEF, a 2-week oral KE treatment increased cardiac output and reduced cardiac filling pressures and ventricular stiffness. At peak exercise, KE treatment markedly decreased pulmonary capillary wedge pressure and improved pressure-flow relationship.
Study context
- Population
- Patients with T2DM and heart failure with preserved ejection fraction (HFpEF)completed crossover
- Participants
- 24 patients
- Comparison
- Oral ketone ester vs placebo
- Primary endpoint
- Cardiac output
- Follow-up
- During the 4-hour rest period
Primary result
As reported in the abstract
4-hour rest period
Difference
0.2 L/min
95% CI 0.1–0.3
KE vs Placebo
difference 0.2 L/min (95% CI 0.1–0.3)
Further findings
Circulating 3-hydroxybutyrate · 4-hour resting period
| Outcome | difference (mL) (95% CI) | |
|---|---|---|
| Stroke volume at peak exercise · increase with KE | 10 (0–20) | |
| −100102030Difference, mL (linear scale) |
| Outcome | difference (mm Hg) (95% CI) |
|---|---|
| Pulmonary capillary wedge pressure · decrease at rest | 1 (−2 to 0) |
| Pulmonary capillary wedge pressure · decrease at peak exercise | 5 (−9 to −1) |
- Circulating 3-hydroxybutyrate — 10-fold higher with ketone ester (KE)
- P<0.001
Pressure-flow relationship (∆PCWP/∆cardiac output) during exercise
- Decreased significantly with KE
- P < 0.001
LV end-diastolic pressure-volume relationship
- Right-shifted with KE, suggestive of reduced LV stiffness and improved compliance
Patients on SGLT2 inhibitors and GLP-1 analogs (subgroup)
- Favorable hemodynamic responses to KE also observed
Original publication
Randomized Crossover Trial of 2-Week Ketone Ester Treatment in Patients With Type 2 Diabetes and Heart Failure With Preserved Ejection Fraction. Circulation. Published 20 August 2024. doi:10.1161/circulationaha.124.069732
Summarised from the published abstract; every number is checked against it