The high energy demands of the heart are met primarily by the mitochondrial oxidation of fatty acids and glucose. However, in heart failure there is a decrease in cardiac mitochondrial oxidative metabolism and glucose oxidation that can lead to an energy starved heart. Ketone bodies are readily oxidized by the heart, and can provide an additional source of energy for the failing heart. Ketone oxidation is increased in the failing heart, which may be an adaptive response to lessen the severity of heart failure. While ketone have been widely touted as a “thrifty fuel”, increasing ketone oxidation in the heart does not increase cardiac efficiency (cardiac work/oxygen consumed), but rather does provide an additional fuel source for the failing heart. Increasing ketone supply to the heart and increasing mitochondrial ketone oxidation increases mitochondrial tricarboxylic acid cycle activity. In support of this, increasing circulating ketone by iv infusion of ketone bodies acutely improves heart function in heart failure patients. Chronically, treatment with sodium glucose co-transporter 2 inhibitors, which decreases the severity of heart failure, also increases ketone body supply to the heart. While ketogenic diets increase circulating ketone levels, minimal benefit on cardiac function in heart failure has been observed, possibly due to the fact that these dietary regimens also markedly increase circulating fatty acids. Recent studies, however, have suggested that administration of ketone ester cocktails may improve cardiac function in heart failure. Combined, emerging data suggests that increasing cardiac ketone oxidation may be a therapeutic strategy to treat heart failure.

心脏的高能量需求主要通过脂肪酸和葡萄糖的线粒体氧化来满足。但是，在心力衰竭中，心脏线粒体的氧化代谢和葡萄糖氧化会降低，这会导致能量不足的心脏。酮体容易被心脏氧化，并可以为心脏衰竭提供额外的能量来源。衰竭心脏中的酮氧化增加，这可能是减轻心脏衰竭严重程度的适应性反应。尽管酮被广泛宣传为“节俭燃料”，但增加心脏中的酮氧化并不会增加心脏效率（心脏功/耗氧量），但确实为心脏衰竭提供了额外的燃料来源。增加对心脏的酮供应和增加线粒体酮氧化增加线粒体三羧酸循环活性。为此，通过增加循环酮iv输注酮体可显着改善心力衰竭患者的心功能。长期而言，使用钠葡萄糖共转运蛋白2抑制剂治疗可降低心力衰竭的严重程度，也可增加向心脏提供的酮体。生酮饮食可增加循环酮水平，但已观察到心力衰竭对心脏功能的益处最小，这可能是由于这些饮食方案还显着增加了循环脂肪酸的事实。但是，最近的研究表明，服用酮酯混合物可以改善心力衰竭患者的心功能。综合的新兴数据表明，增加心脏酮氧化可能是治疗心力衰竭的治疗策略。