
In a study involving 24 patients with type 2 diabetes (T2DM) and heart failure with preserved ejection fraction (HFpEF), a 2-week oral ketone ester (KE) treatment significantly improved cardiac function. During the treatment period, circulating levels of 3-hydroxybutyrate increased tenfold, resulting in a 0.2 L/min increase in cardiac output compared to placebo. KE treatment also reduced pulmonary capillary wedge pressure at rest and peak exercise, decreased the pressure-flow relationship during exercise, and increased stroke volume by 10 mL at peak exercise. Additionally, the treatment right-shifted the left ventricular end-diastolic pressure-volume relationship, indicating reduced ventricular stiffness and improved compliance. These findings suggest that modulating ketone levels may be a promising treatment strategy for patients with T2DM and HFpEF.
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