Ketone bodies in acute heart failure: fuel for thought

Published:November 16, 2022DOI:

      Graphical abstract

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Cardiac Failure
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Cleland JGF
        • Pfeffer MA
        • Clark AL
        • et al.
        The struggle towards a Universal Definition of Heart Failure—how to proceed?.
        Eur Heart J. 2021; 42: 2331-2343
        • Mullens W
        • Dauw J
        • Martens P
        • et al.
        Acetazolamide in Acute Decompensated Heart Failure with Volume Overload.
        New England Journal of Medicine. 2022; 387: 1185-1195
        • Trullàs JC
        • Morales-Rull JL
        • Casado J
        • Ramírez AF
        • Manzano L
        • Formiga F.
        Rationale and design of the “Safety and Efficacy of the Combination of Loop with Thiazide-type Diuretics in Patients with Decompensated Heart Failure (CLOROTIC) Trial:” a double-blind, randomized, placebo-controlled study to determine the effect of combined diuretic therapy (loop diuretics with thiazide-type diuretics) among patients with decompensated heart failure.
        J Card Fail. 2016; 22: 529-536
        • Inzucchi SE
        • Zinman B
        • Fitchett D
        • et al.
        How Does Empagliflozin Reduce Cardiovascular Mortality? Insights From a Mediation Analysis of the EMPA-REG OUTCOME Trial.
        Diabetes Care. 2017; 41: 356-363
        • Griffin M
        • Rao VS
        • Ivey-Miranda J
        • et al.
        Empagliflozin in Heart Failure.
        Circulation. 2020; 142: 1028-1039
        • Voors AA
        • Angermann CE
        • Teerlink JR
        • et al.
        The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial.
        Nat Med. 2022; 28: 568-574
        • Vaduganathan M
        • Docherty KF
        • Claggett BL
        • et al.
        SGLT-2 inhibitors in patients with heart failure: a comprehensive meta-analysis of five randomised controlled trials.
        The Lancet. 2022; 400: 757-767
        • Lopaschuk GD
        • Verma S.
        Mechanisms of cardiovascular benefits of sodium glucose co-transporter 2 (SGLT2) inhibitors: a state-of-the-art review.
        Basic to Translational Science. 2020; 5: 632-644
        • Lopaschuk GD
        • Karwi QG
        • Ho KL
        • Pherwani S
        • Ketema EB.
        Ketone metabolism in the failing heart.
        Biochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids. 2020; 1865158813
        • Ferrannini E
        • Baldi S
        • Frascerra S
        • et al.
        Shift to Fatty Substrate Utilization in Response to Sodium–Glucose Cotransporter 2 Inhibition in Subjects Without Diabetes and Patients With Type 2 Diabetes.
        Diabetes. 2016; 65: 1190-1195
        • Lommi J
        • Kupari M
        • Koskinen P
        • et al.
        Blood ketone bodies in congestive heart failure.
        J Am Coll Cardiol. 1996; 28: 665-672
        • Kupari M
        • Lommi J
        • Ventilä M
        • Karjalainen U.
        Breath acetone in congestive heart failure.
        Am J Cardiol. 1995; 76: 1076-1078
        • Marcondes-Braga FG
        • Gioli-Pereira L
        • Bernardez-Pereira S
        • et al.
        Exhaled breath acetone for predicting cardiac and overall mortality in chronic heart failure patients.
        ESC Heart Fail. 2020; 7: 1744-1752
        • Yokokawa T
        • Sato T
        • Suzuki S
        • et al.
        Change of exhaled acetone concentration levels in patients with acute decompensated heart failure a preliminary study.
        Int Heart J. 2018; 59: 808-812
        • Damman K
        • Beusekamp JC
        • Boorsma EM
        • et al.
        Randomized, double-blind, placebo-controlled, multicentre pilot study on the effects of empagliflozin on clinical outcomes in patients with acute decompensated heart failure (EMPA-RESPONSE-AHF).
        Eur J Heart Fail. 2020; 22: 713-722
        • Voorrips SN BEBJ
        • et al.
        Longitudinal changes in circulating ketone body levels in patients with acute heart failure: A post-hoc analysis of the EMPA-Response-AHF Trial.
        J Card Fail. 2022; (Published online)
        • Murashige D
        • Jang C
        • Neinast M
        • et al.
        Comprehensive quantification of fuel use by the failing and nonfailing human heart.
        Science. 2020; 370 (1979): 364-368
        • Takahara S
        • Soni S
        • Maayah ZH
        • Ferdaoussi M
        • Dyck JRB.
        Ketone therapy for heart failure: current evidence for clinical use.
        Cardiovasc Res. 2022; 118: 977-987
        • Nielsen R
        • Møller N
        • Gormsen LC
        • et al.
        Cardiovascular Effects of Treatment With the Ketone Body 3-Hydroxybutyrate in Chronic Heart Failure Patients.
        Circulation. 2019; 139: 2129-2141
        • Selvaraj S
        • Hu R
        • Vidula MK
        • et al.
        Acute Echocardiographic Effects of Exogenous Ketone Administration in Healthy Participants.
        Journal of the American Society of Echocardiography. 2022; 35: 305-311
        • Lala A
        • Mentz RJ.
        The JCF Reviewer Mentorship Program.
        J Card Fail. 2022; 28: 1-2

      Linked Article