Background

Interest in therapeutic applications of exogenous ketones has grown significantly, spanning patients with heart failure to endurance athletes. Exogenous ketones engender significant effects on cardiac function in heart failure and provide an ergogenic benefit in athletes. The aim of this study was to assess the effects of exogenous ketones on cardiac function in healthy participants.

Methods

In a single-arm intervention study, 20 fasting, healthy participants underwent comprehensive echocardiography (two-dimensional, Doppler, and strain) before and 30 min after weight-based oral ketone ester administration. The relationship between changes in log-transformed biomarker levels and change in absolute global longitudinal strain (GLS) was assessed using linear regression.

Results

The mean age was 30 ± 7 years, 50% were women, 45% were nonwhite, and the average body mass index was 24.3 ± 3.1 kg/m². Ketone ingestion acutely elevated β-hydroxybutyrate levels from a median of 0.13 mmol/L (interquartile range, 0.10-0.37 mmol/L) to 3.23 mmol/L (interquartile range, 2.40-4.97 mmol/L) (P < .001). After ketone ester consumption, systolic blood pressure, heart rate, biventricular function, left ventricular GLS, and left atrial (LA) strain all augmented, while systemic vascular resistance decreased. Displayed as mean change, increases in ejection fraction (3.1%; 95% CI, 2.0%-4.2%; P < .001), GLS (2.0%; 95% CI, 1.4%-2.7%; P < .001), right ventricular S′ (1.1 cm/sec; 95% CI, 0.4-1.8 cm/sec; P = .004), LA reservoir strain (7%; 95% CI, 3%-12%; P = .005), and LA contractile strain (4%; 2%-6%; P = .001) were observed. During robustly achieved ketosis, change in GLS was inversely associated with change in nonesterified fatty acids (P = .019).

Conclusions

In a single-arm study, systolic blood pressure, heart rate, biventricular function, and LV and LA strain acutely augmented after ketone ester ingestion in healthy, fasting participants, similar to several effects observed in the failing heart. These data may provide supporting data for the ergogenic benefits observed in athletes and may become increasingly relevant with exogenous ketone consumption across a variety of cardiovascular and noncardiovascular applications.

中文翻译：

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健康参与者外源性酮给药的急性超声心动图效应

背景

从心力衰竭患者到耐力运动员，对外源性酮的治疗应用的兴趣显着增加。外源性酮对心力衰竭的心脏功能产生显着影响，并为运动员提供增效作用。本研究的目的是评估外源性酮对健康参与者心脏功能的影响。

方法

在一项单臂干预研究中，20 名禁食的健康参与者在基于体重的口服酮酯给药之前和之后 30 分钟接受了全面的超声心动图检查（二维、多普勒和应变）。使用线性回归评估对数转换的生物标志物水平的变化与绝对全局纵向应变 (GLS) 的变化之间的关系。

结果

平均年龄为 30 ± 7 岁，50% 为女性，45% 为非白人，平均体重指数为 24.3 ± 3.1 kg/m ²。摄入酮会使 β-羟基丁酸水平从中位数 0.13 mmol/L（四分位距，0.10-0.37 mmol/L）急剧升高至 3.23 mmol/L（四分位距，2.40-4.97 mmol/L）（P < .001 ）  。酮酯消耗后，收缩压、心率、双心室功能、左心室 GLS 和左心房 (LA) 应变均增加，而全身血管阻力降低。显示为平均变化，射血分数增加（3.1%；95% CI，2.0%-4.2%；P  < .001），GLS（2.0%；95% CI，1.4%-2.7%；P  < .001），右心室 S'（1.1 厘米/秒；95% CI，0.4-1.8 厘米/秒；P = .004）、LA 储层应变（7%；95% CI，3%-12%；P  = .005）和 LA 收缩应变（4%；2%-6%；P  = .001）。在稳健实现酮症期间，GLS 的变化与非酯化脂肪酸的变化呈负相关（P  = .019）。

结论

在一项单臂研究中，在健康、禁食的参与者中摄入酮酯后，收缩压、心率、双心室功能以及 LV 和 LA 应变急剧增加，类似于在衰竭心脏中观察到的几种效应。这些数据可能为在运动员身上观察到的增效作用提供支持数据，并且可能与各种心血管和非心血管应用中的外源性酮消耗越来越相关。