Effect of Hyperketonemia on Myocardial Function in Patients With Heart Failure and Type 2 Diabetes

Carolina Solis-Herrera, Yuejuan Qin, Henri Honka, Eugenio Cersosimo, Curtis Triplitt, Sivaram Neppala, Jemena Rajan, Francisca M. Acosta, Alexander J. Moody, Patricio Iozzo, Peter Fox, Geoffrey Clarke, Ralph A. Defronzo

Producción científica: Articlerevisión exhaustiva

Resumen

We examined the effect of increased levels of plasma ketones on left ventricular (LV) function, myocardial glucose uptake (MGU), and myocardial blood flow (MBF) in patients with type 2 diabetes (T2DM) with heart failure. Three groups of patients with T2DM (n = 12 per group) with an LV ejection fraction (EF) #50% received incremental infusions of β-hydroxybutyrate (β-OH-B) for 3–6 h to increase the plasma β-OH-B concentration throughout the physiologic (groups I and II) and pharmacologic (group III) range. Cardiac MRI was performed at baseline and after each β-OH-B infusion to provide measures of cardiac function. On a separate day, group II also received a sodium bicarbonate (NaHCO3) infusion, thus serving as their own control for time, volume, and pH. Additionally, group II underwent positron emission tomography study with18F-fluoro2-deoxyglucose to examine effect of hyperketonemia on MGU. Groups I, II, and III achieved plasma β-OH-B levels (mean ± SEM) of 0.7 ± 0.3, 1.6 ± 0.2, 3.2 ± 0.2 mmol/L, respectively. Cardiac output (CO), LVEF, and stroke volume (SV) increased significantly during β-OH-B infusion in groups II (CO, from 4.54 to 5.30; EF, 39.9 to 43.8; SV, 70.3 to 80.0) and III (CO, from 5.93 to 7.16; EF, 41.1 to 47.5; SV, 89.0 to 108.4), and did not change with NaHCO3 infusion in group II. The increase in LVEF was greatest in group III (P < 0.001 vs. group II). MGU and MBF were not altered by β-OH-B. In patients with T2DM and LVEF #50%, increased plasma β-OH-B level significantly increased LV function dose dependently. Because MGU did not change, the myocardial benefit of β-OH-B resulted from providing an additional fuel for the heart without inhibiting MGU.

Idioma originalEnglish (US)
Páginas (desde-hasta)43-52
Número de páginas10
PublicaciónDiabetes
Volumen74
N.º1
DOI
EstadoPublished - ene 2025

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

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