TY - JOUR
T1 - Beneficial Effects of Ketone Ester in Patients With Cardiogenic Shock
T2 - A Randomized, Controlled, Double-Blind Trial
AU - Berg-Hansen, Kristoffer
AU - Christensen, Kristian Hylleberg
AU - Gopalasingam, Nigopan
AU - Nielsen, Roni
AU - Eiskjær, Hans
AU - Møller, Niels
AU - Birkelund, Thomas
AU - Christensen, Steffen
AU - Wiggers, Henrik
N1 - Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
PY - 2023/10
Y1 - 2023/10
N2 - Background: Cardiogenic shock (CS) is a life-threatening condition with sparse treatment options. The ketone body 3-hydroxybutyrate has favorable hemodynamic effects in patients with stable chronic heart failure. Yet, the hemodynamic effects of exogenous ketone ester (KE) in patients with CS remain unknown. Objectives: The authors aimed to assess the hemodynamic effects of single-dose enteral treatment with KE in patients with CS. Methods: In a double-blind, crossover study, 12 patients with CS were randomized to an enteral bolus of KE and isocaloric, isovolumic placebo containing maltodextrin. Patients were assessed with pulmonary artery catheterization, arterial blood samples, echocardiography, and near-infrared spectroscopy for 3 hours following each intervention separated by a 3-hour washout period. Results: KE increased circulating 3-hydroxybutyrate (2.9 ± 0.3 mmol/L vs 0.2 ± 0.3 mmol/L, P < 0.001) and was associated with augmented cardiac output (area under the curve of relative change: 61 ± 22 L vs 1 ± 18 L, P = 0.044). Also, KE increased cardiac power output (0.07 W [95% CI: 0.01-0.14]; P = 0.037), mixed venous saturation (3 percentage points [95% CI: 1-5 percentage points]; P = 0.010), and forearm perfusion (3 percentage points [95% CI: 0-6 percentage points]; P = 0.026). Right (P = 0.048) and left (P = 0.017) ventricular filling pressures were reduced whereas heart rate and mean arterial and pulmonary arterial pressures remained similar. Left ventricular ejection fraction improved by 4 percentage points (95% CI: 2-6 percentage points; P = 0.005). Glucose levels decreased by 2.6 mmol/L (95% CI: −5.2 to 0.0; P = 0.047) whereas insulin levels remained unaltered.
AB - Background: Cardiogenic shock (CS) is a life-threatening condition with sparse treatment options. The ketone body 3-hydroxybutyrate has favorable hemodynamic effects in patients with stable chronic heart failure. Yet, the hemodynamic effects of exogenous ketone ester (KE) in patients with CS remain unknown. Objectives: The authors aimed to assess the hemodynamic effects of single-dose enteral treatment with KE in patients with CS. Methods: In a double-blind, crossover study, 12 patients with CS were randomized to an enteral bolus of KE and isocaloric, isovolumic placebo containing maltodextrin. Patients were assessed with pulmonary artery catheterization, arterial blood samples, echocardiography, and near-infrared spectroscopy for 3 hours following each intervention separated by a 3-hour washout period. Results: KE increased circulating 3-hydroxybutyrate (2.9 ± 0.3 mmol/L vs 0.2 ± 0.3 mmol/L, P < 0.001) and was associated with augmented cardiac output (area under the curve of relative change: 61 ± 22 L vs 1 ± 18 L, P = 0.044). Also, KE increased cardiac power output (0.07 W [95% CI: 0.01-0.14]; P = 0.037), mixed venous saturation (3 percentage points [95% CI: 1-5 percentage points]; P = 0.010), and forearm perfusion (3 percentage points [95% CI: 0-6 percentage points]; P = 0.026). Right (P = 0.048) and left (P = 0.017) ventricular filling pressures were reduced whereas heart rate and mean arterial and pulmonary arterial pressures remained similar. Left ventricular ejection fraction improved by 4 percentage points (95% CI: 2-6 percentage points; P = 0.005). Glucose levels decreased by 2.6 mmol/L (95% CI: −5.2 to 0.0; P = 0.047) whereas insulin levels remained unaltered.
KW - 3-hydroxybutyrate
KW - cardiac output
KW - cardiogenic shock
KW - invasive hemodynamics
KW - ketone ester
KW - metabolism
U2 - 10.1016/j.jchf.2023.05.029
DO - 10.1016/j.jchf.2023.05.029
M3 - Journal article
C2 - 37452805
SN - 2213-1779
VL - 11
SP - 1337
EP - 1347
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 10
ER -