Implications of Altered Ketone Metabolism and Therapeutic Ketosis in Heart Failure

This review summarizes evidence for ketone metabolic modulation in heart failure (HF), covering normal myocardial ketone use, alterations in the failing heart, effects of therapeutic ketosis in animals and humans with HF, and ketosis associated with sodium-glucose cotransporter 2 inhibitors. It states that the failing heart reduces fatty acid and glucose oxidation while ketone metabolism increases, and that limited data show beneficial effects of exogenous ketone therapy in animal models and humans with HF. It notes that important questions remain about mechanism and use.