This non-systematic review covers studies published between 1987 and 2024 on ketone bodies and myocardial perfusion. It examines normal coronary blood flow regulation, the role of ketone bodies in myocardial perfusion in health and disease, and the potential of exogenous ketone supplementation in exercise and cardiac disease states including ischemia, heart failure and the aging heart. The authors report that ketone bodies improve myocardial blood flow and ejection fraction in healthy human subjects and have beneficial effects on cardiac output and left heart filling pressures in patients with decompensated heart failure. They state that further studies are needed in aging populations, during exercise and in myocardial ischemia.
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