Acute Oral Ketones or Carbohydrate Supplement Modify Heart Function in Heart Failure?

Does Oral Intake of Beta-hydroxybutyrate Decrease Left Ventricular End-systolic Volume at Cardiac Magnetic Resonance in Patients With Heart Failure Compared to Carbohydrate Placebo?

Does oral intake of exogenous ketone salt improve heart function measured by cardiac MRI in heart failure compared to oral intake of a carbohydrate placebo?

This study will help to quantify heart and kidney ketone uptake with or without an exogenous ketone salt in heart failure condition.

Participants will have 2 different cardiac MRI to perform:

1. Fasting with exogenous ketone salt supplement
2. Fasting with exogenous carbohydrate supplement

Inclusion Criteria:

• Patients with heart failure with left ventricle ejection fraction of 40%
• Heart failure of ischemic or dilated etiology
• Ambulatory patient with a NYHA functional class of II-III;
• Stable symptoms and no change in medical therapy in the last month.

Exclusion Criteria:

• Diabetes
• Patients treated with any SGLT2i;
• Chronic kidney disease
• Acute coronary syndrome in the last 3 months;
• Use of parenteral inotropic agents;
• Persistent or permanent atrial fibrillation or atrial flutter;
• Presence of pacemaker or defibrillator;
• Medical condition that causes malabsorption of the test material;
• Under ketogenic diet, or using exogenous ketone supplements
• Use of nicotinamide adenine dinucleotide (NAD) precursor supplements