Cardiovascular Disease

A ketogenic‐promoting beverage acutely elevates cardiac function and myocardial blood flow compared to placebo in adults: A cardiac MRI investigation

A placebo-controlled study investigated the acute cardiovascular effects of a ketogenic beverage containing 50 grams of bis-hexanoyl R-1,3-butanediol (BH-BD), a ketone diester known to elevate circulating R-β-hydroxybutyrate (R-BHB). Prior studies using intravenous ketone delivery have shown improvements in cardiac output and perfusion, but oral formulations may offer a more practical and sustained approach.

To evaluate this, healthy adults underwent serial cardiac MRI and blood testing over a 2-hour period following ingestion of BH-BD or a calorie- and volume-matched fat-based placebo. The study assessed changes in cardiac output, myocardial blood flow, and left ventricular strain.

Key Findings:

• Ketone levels: BH-BD raised R-β-hydroxybutyrate to 2.1 mmol/L at 120 minutes. Placebo showed no change.
• Cardiac output (CO): CO increased by 31% with BH-BD, due to higher heart rate (+22%) and stroke volume (+11%). No change occurred with placebo.
• Ejection fraction (EF): Left ventricular EF was higher at 2 hours with BH-BD compared to placebo (64.6% vs. 59.4%). Right ventricular EF trended upward.
• Myocardial blood flow (MBF): MBF rose 29% from baseline after BH-BD; placebo had no effect.
• Myocardial strain: BH-BD improved peak and mean longitudinal strain; mean strain was significantly higher than placebo at 90 and 120 minutes.
• Hemodynamics: Pulmonary transit time decreased 25% with BH-BD, suggesting enhanced circulatory efficiency.
• Tolerability: Mild symptoms (e.g., nausea, bloating) occurred in a few BH-BD participants. No serious adverse effects were reported.

BH-BD ingestion rapidly elevated blood ketone levels and produced significant acute improvements in cardiac output, myocardial blood flow, and myocardial strain compared to placebo. These findings suggest that exogenous ketones may offer short-term cardiovascular benefits and warrant further investigation in clinical settings.