Treatment with Ketone Ester is beneficial in patients with cardiogenic shock: JACC
Denmark: Treatment with a single enteral bolus of ketone ester (KE) improved ejection fraction and glycemic control and increased cardiac output in patients with cardiogenic shock (CS), according to the KETO-SHOCK1 trial. The findings from the randomized, controlled, double-blind trial were published in JACC: Heart Failure.
Cardiogenic shock is a life-threatening condition with limited treatment options. The ketone body 3-hydroxybutyrate is reported to have favourable hemodynamic effects in patients with stable chronic heart failure. However, there is no information on the hemodynamic effects of exogenous KE in patients with cardiogenic shock.
To fill this knowledge gap, Kristoffer Berg-Hansen, Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark, and colleagues aimed to evaluate the hemodynamic effects of single-dose enteral treatment with KE in patients with cardiogenic shock.
The double-blind, crossover study included 12 patients with cardiogenic shock. They were randomized to an enteral bolus of KE and an isocaloric, isovolumic placebo containing maltodextrin. Patients were evaluated with near-infrared spectroscopy, echocardiography, arterial blood samples, and pulmonary artery catheterization for 3 hours after each intervention separated by a 3-hour washout period.
The study led to the following findings:
- Ketone ester increased circulating 3-hydroxybutyrate (2.9 ± 0.3 mmol/L versus 0.2 ± 0.3 mmol/L) and was associated with augmented cardiac output (area under the curve of relative change: 61 ± 22 L versus 1 ± 18 L).
- KE increased cardiac power output (0.07 W), mixed venous saturation (3 percentage points), and forearm perfusion (3 percentage points).
- Right and left 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.
- Glucose levels decreased by 2.6 mmol/L, whereas insulin levels remained unaltered.
"Treatment with ketone ester improved cardiac output, tissue oxygenation, biventricular function, and glycemic control in patients with cardiogenic shock," the researchers concluded.
Reference:
Berg-Hansen K, Christensen KH, Gopalasingam N, Nielsen R, Eiskjær H, Møller N, Birkelund T, Christensen S, Wiggers H. Beneficial Effects of Ketone Ester in Patients With Cardiogenic Shock: A Randomized, Controlled, Double-Blind Trial. JACC Heart Fail. 2023 Jul 1:S2213-1779(23)00306-2. doi: 10.1016/j.jchf.2023.05.029. Epub ahead of print. PMID: 37452805.
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