# Ketonlichaam 3-hydroxybutyraat bij chronisch hartfalen: cardiovasculaire effecten

*geplaatst 2019-04-30 · Hartfalen · Circulation · doi 10.1161/CIRCULATIONAHA.118.036459 · https://hartvaat.nl/2019/04/30/ketonlichaam-3-hydroxybutyraat-bij-chronisch-hartfalen-cardiovasculaire-effecten/*

Studie naar de cardiovasculaire effecten van behandeling met het ketonlichaam 3-hydroxybutyraat bij chronisch hartfalen. Metabole therapie als nieuw concept.

## English: Cardiovascular Effects of Treatment With the Ketone Body 3-Hydroxybutyrate in Chronic Heart Failure Patients.

This study demonstrated that infusion of the ketone body 3-hydroxybutyrate improves cardiac output and left ventricular ejection fraction in patients with chronic heart failure, supporting the metabolic hypothesis that ketone utilization is a beneficial cardiac adaptation.

## Abstract (original, from the publication)

BACKGROUND: Myocardial utilization of 3-hydroxybutyrate (3-OHB) is increased in patients with heart failure and reduced ejection fraction (HFrEF). However, the cardiovascular effects of increased circulating plasma-3-OHB levels in these patients are unknown. Consequently, the authors' aim was to modulate circulating 3-OHB levels in HFrEF patients and evaluate: (1) changes in cardiac output (CO); (2) a potential dose-response relationship between 3-OHB levels and CO; (3) the impact on myocardial external energy efficiency (MEE) and oxygen consumption (MVO2); and (4) whether the cardiovascular response differed between HFrEF patients and age-matched volunteers. METHODS: Study 1: 16 chronic HFrEF patients (left ventricular ejection fraction: 37±3%) were randomized in a crossover design to 3-hour of 3-OHB or placebo infusion. Patients were monitored invasively with a Swan-Ganz catheter and with echocardiography. Study 2: In a dose-response study, 8 HFrEF patients were examined at increasing 3-OHB infusion rates. Study 3 to 4: 10 HFrEF patients and 10 age-matched volunteers were randomized in a crossover design to 3-hour 3-OHB or placebo infusion. MEE and MVO2 were evaluated using 11C-acetate positron emission tomography. RESULTS: 3-OHB infusion increased circulating levels of plasma 3-OHB from 0.4±0.3 to 3.3±0.4 mM ( P<0.001). CO rose by 2.0±0.2 L/min ( P<0.001) because of an increase in stroke volume of 20±2 mL ( P<0.001) and heart rate of 7±2 beats per minute (bpm) ( P<0.001). Left ventricular ejection fraction increased 8±1% ( P<0.001) numerically. There was a dose-response relationship with a significant CO increase of 0.3 L/min already at plasma-3-OHB levels of 0.7 mM ( P<0.001). 3-OHB increased MVO2 without altering MEE. The response to 3-OHB infusion in terms of MEE and CO did not differ between HFrEF patents and age-matched volunteers. CONCLUSIONS: 3-OHB has beneficial hemodynamic effects in HFrEF patients without impairing MEE. These beneficial effects are detectable in the physiological concentration range of circulating 3-OHB levels. The hemodynamic effects of 3-OHB were observed in both HFrEF patients and age-matched volunteers. 3-OHB may potentially constitute a novel treatment principle in HFrEF patients.

Auteurs: Roni Nielsen, Niels Møller, Lars C Gormsen, Lars Poulsen Tolbod, Nils Henrik Hansson, Jens Sorensen, Hendrik Johannes Harms, Jørgen Frøkiær, Hans Eiskjaer, Nichlas Riise Jespersen, Søren Mellemkjaer, Thomas Ravn Lassen, Kasper Pryds, Hans Erik Bøtker, Henrik Wiggers

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Bron: Circulation, https://doi.org/10.1161/CIRCULATIONAHA.118.036459. Bijgewerkt 2026-07-03T18:38:42Z. Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.