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. 2024 Mar 27;149(19):1474–1489. doi: 10.1161/CIRCULATIONAHA.123.067971

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© 2024 The Authors.

Circulation is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution Non-Commercial-NoDerivs License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited, the use is noncommercial, and no modifications or adaptations are made.

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Figure 2. — Hemodynamic parameters during KE and IC treatment. Mean or geometric mean with bars indicating SE. A, Cardiac output (CO; P=0.014) was higher, and pulmonary capillary wedge pressure (PCWP; P=0.001; B) and PCWP/CO (C; P<0.001) were lower after 14-day treatment with ketone ester (KE) compared with the isocaloric comparator (IC). D, Circulating trough levels of 3-hydroxybutyrate (3-OHB) were similarly higher after 14-day KE treatment in patients with and without ongoing sodium-glucose cotransporter 2 inhibitor (SGLT2-inh) treatment. E, Forest plot displays the between-treatment pairwise comparisons (coefficients) and 95% CI in each subgroup, and P values indicate subgroup comparisons for interaction testing. There were no significant interactions between treatment with SGLT2 inhibitors and treatment response to KE on CO or PCWP at rest. F, The left ventricular (LV) end-diastolic pressure-volume relationship remained similar during each treatment, whereas KE improved LV unloading by reducing LV end-diastolic pressure, volume, and LV stiffness. G, Cardiac unloading was supported by a reduction in N-terminal pro-B-type natriuretic-peptide (NT-proBNP) during KE treatment compared with IC and measurements at randomization (P=0.010). NS indicates not statistically different. * P<0.05 vs IC; ***P<0.001 vs IC.