Cardiac ketone body metabolism

This review covers the ketone bodies d-beta-hydroxybutyrate and acetoacetate, which can be used as glucose-sparing energy substrates by oxidative tissues including the heart and which also act as signalling molecules through G-protein coupled receptors and histone deacetylases. It reports that ketone body concentration increases in diabetes mellitus and heart failure, and that recent evidence indicates increased ketone body metabolism is a feature of heart failure, accompanied by other changes in substrate selection. The authors state it is unknown whether this change is adaptive or maladaptive.