This randomized, single-blind, placebo-controlled crossover study gave 12 patients with heart failure with reduced ejection fraction an oral dose of (R)-1,3-butanediol (0.5 g/kg) or taste-matched placebo, with echocardiography and blood sampling hourly for 6 hours. Butanediol raised circulating 3-hydroxybutyrate by 1400 micromol/L and increased cardiac output by 0.9 L/min compared with placebo (both p < 0.001). Stroke volume rose by 15 mL, left ventricular ejection fraction rose by 3 percentage points, heart rate was similar between treatments, and free fatty acids and glucose decreased.
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