This study compared 19 patients with heart failure with reduced ejection fraction (HFrEF) and 9 controls, sampling arterial blood and coronary sinus blood to measure myocardial extraction of substrates. In a separate experiment, 11 HFrEF patients and 6 controls were measured 80 minutes after drinking 25 g of ketone ester. Fasting substrate levels and fractional extractions did not differ between groups, and the ketone ester raised beta-hydroxybutyrate 12.9-fold. Beta-hydroxybutyrate fractional extraction correlated directly with myocardial delivery (r = 0.90), left ventricular mass, and left ventricular diameter, and inversely with ejection fraction.
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