We examined the effect of increased plasma ketones on left ventricular (LV) function, myocardial glucose uptake (MGU), and myocardial blood flow (MBF) in type 2 diabetes (T2DM) patients with heart failure (HF). Three groups (I,II,III) of T2DM (12 per group) with LV ejection fraction ≤50% received incremental infusions of β-OH-B for 3-6 hours to raise 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 NaHCO3 infusion, thus serving as their own control for time, volume, and pH. Additionally, Group II underwent positron emission tomography study with 18F-fluoro-2-deoxyglucose to examine effect of hyperketonemia on MGU. Groups I, II, III achieved plasma β-OH-B levels of 0.7±0.3, 1.6±0.2, 3.2±0.2 mmol/L, respectively. Cardiac output, LVEF, and stroke volume increased significantly during β-OH-B infusion in Groups II (CO, 4.54 to 5.30; EF, 39.9 to 43.8; SV, 70.3 to 80.0) and III (CO, 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 T2DM patients with LVEF≤50%, increased plasma β-OH-B significantly increased LV function dose-dependently. Since MGU did not change, the myocardial benefit of β-OH-B resulted from providing an additional fuel for the heart without inhibiting MGU.

中文翻译：

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高酮血症对心力衰竭和 2 型糖尿病患者心肌功能的影响


我们检查了血浆酮体增加对 2 型糖尿病 （T2DM） 心力衰竭 （HF） 患者左心室 （LV） 功能、心肌葡萄糖摄取 （MGU） 和心肌血流量 （MBF） 的影响。LV 射血分数为 ≤50% 的三组 （I、II、III） 的 T2DM （每组 12 例） 接受 β-OH-B 增量输注 3-6 小时，以提高血浆 β-OH-B 浓度整个生理学 （I 组和 II） 和药物学 （III 组） 范围。在基线和每次 β-OH-B 输注后进行心脏 MRI 检查，以提供心脏功能的测量。在另一天，第 II 组也接受了 NaHCO3 输注，从而作为他们自己的时间、体积和 pH 值的对照。此外，第 II 组进行 18F-fluoro-2-脱氧葡萄糖正电子发射断层扫描研究，以检查高酮血症对 MGU 的影响。I、II、III 组血浆 β-OH-B 水平分别为 0.7±0.3、1.6±0.2、3.2±0.2 mmol/L。II 组 β（CO，4.54 至 5.30;EF，39.9 至 43.8;SV，70.3 至 80.0）和 III（CO，5.93 至 7.16;EF，41.1 至 47.5;SV，89.0 至 108.4），并且在第 II 组中随着 NaHCO3 的输注而没有变化。III 组 LVEF 增加最大 （p<0.001 vs II 组）。MGU 和 MBF 未被 β-OH-B 改变。在 LVEF≤50% 的 T2DM 患者中，血浆 β-OH-B 升高显着增加 LV 功能呈剂量依赖性。由于 MGU 没有改变，β-OH-B 的心肌益处是由于在不抑制 MGU 的情况下为心脏提供额外的燃料。