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

Increasing evidence suggests cardiac function improves in healthy and failing hearts alongside circulating ketones (1-4 mM). This study characterized cardiac function and blood flow responses to a ketogenic beverage compared to a volume/calorie matched placebo with repeated imaging over 120 min. This was a two-group, placebo-controlled, acute cardiac imaging study. Adults without cardiac abnormalities underwent baseline cardiac MRI including quantitative myocardial perfusion to measure myocardial blood flow (MBF). Subjects consumed 50 g of a ketogenic-promoting beverage [bis-hexanoyl R-1-3-butanediol (BH-BD)] (BH-BD; n = 11) or a calorically/volume-matched lipid-based placebo (PL; n = 10) with cardiac MRI every 15-30 min. Following 120 min, subjects underwent a final scan including MBF measurement. R-BHB and glucose were measured at every timepoint. 120 min following BH-BD consumption, R-BHB reached 2.1 mM. Cardiac output (CO) was elevated compared to PL (p < 0.05) and increased +31% 120 min after BH-BD ingestion (p < 0.001). CO elevation was due to increased stroke volume (+11%; p = 0.02) and heart rate (+22%; p < 0.001). MBF increased 29% from baseline (p < 0.001). PL did not induce differences in cardiac parameters. 50 g BH-BD ingestion achieves exogenous ketosis and is associated with elevated MBF and CO providing evidence supporting their use as a therapeutic clinical agent.