Ketone metabolism in the failing heart

This review describes ketone metabolism in the failing heart. It states that ketone oxidation is increased in the failing heart, that increasing it does not raise cardiac efficiency but provides an additional fuel source, and that intravenous ketone infusion acutely improves heart function in heart failure patients. It notes that sodium glucose co-transporter 2 inhibitors also increase ketone supply to the heart, that ketogenic diets have shown minimal benefit on cardiac function possibly because they also markedly increase circulating fatty acids, and that ketone ester cocktails may improve cardiac function in heart failure.