The cardiac and hemodynamic effects of ketone bodies are abnormalin patients with type 1 diabetes: a randomized controlled trial
Impaired cardiac ketone oxidative capacity is a possible disease mechanism in the development of diabetic cardiomyopathy. We examined whether the cardiovascular effects of ketone bodies are different in patients with type 1 diabetes (T1D) compared with healthy controls.
Nine patients with T1D and eight age-matched healthy controls were randomized in a single-blind crossover design to receive a three-hour infusion of 3-hydroxybutyrate (3-OHB) or tonicity-matched saline in random order, separated by a one-hour washout period. Assessor-blinded echocardiographic evaluation of cardiovascular function was performed at baseline and following 150 minutes of each intervention.
Circulating 3-OHB increased during 3-OHB infusion vs. placebo in healthy controls, with a similar increase in patients with T1D. In healthy controls, 3-OHB infusion increased cardiac output by 1.9±0.4 L/min but only by 0.5±0.1 L/min in patients with T1D. Stroke volume increased by 14±5 mL and left ventricular (LV) ejection fraction by 3±1 percentage points in healthy controls with no change in patients with T1D. During 3-OHB infusion in patients with T1D, LV global wasted work increased and LV global work efficiency decreased. In conclusion, patients with T1D displayed an abnormal cardiovascular response to 3-OHB infusion. Diabetic cardiomyopathy in patients may involve impaired cardiac ketone metabolism.