KETO-HFpEF was a randomized, crossover, placebo-controlled trial of acute ketone ester (KE) dosing in 20 symptomatic participants with heart failure with preserved ejection fraction (average age 71 +/- 8 years, 60 percent women). KE did not improve peak VO2 (10.4 +/- 3.6 vs 10.5 +/- 4.0 mL/kg/min; P = 0.75) or time to exhaustion during constant-intensity exercise (9.7 +/- 7.3 vs 8.7 +/- 4.4 minutes; P = 0.51). At rest, KE increased cardiac output by 0.6 L/min and lowered total peripheral resistance, and during exercise it lowered respiratory exchange ratios, nonesterified fatty acids, glucose and estimated left ventricular filling pressures.
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