Modulation of Circulating Levels of the Ketone Body 3-hydroxybutyrate in Patients With Chronic Heart Failure: Cardiovascular Effects

NCT ID: NCT04443426

Last Updated: 2022-08-18

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: PHASE2
• Total Enrollment: 8 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2019-04-25
• Study Completion Date: 2022-11-01

Brief Summary

The ketone body 3-hydroxybutyrate (3-OHB) is a naturally occurring energy substrate, and is associated with increased life span and improved health. We have previously shown that intravenous 3-OHB treatment increases myocardial blood flow > 70% in healthy humans and data from our group show that 3-OHB increases cardiac output by 40 % in patients with heart failure.

In this study the investigators aim to investigate:

1. If this effect is reproducible with a commercially available oral ketone supplements

2. The safety of commercially available ketone supplements in heart failure patients

Detailed Description

Heart Failure (HF) is a major public health issue because the disease affects 1-2% of the Western population and the lifetime risk of HF is 20%. HF is responsible for 1-2% of all healthcare expenditures. Despite major improvements in the management and care of patients with HF, the 1-year mortality in patients with HF is 13 % and >50% of HF-patients is admitted during a 2.5 year period. Furthermore patients with HF have markedly decreased physical capacity and quality of life. Thus, there is a need for new treatment modalities in this group of patients.

Ketone bodies are produced in the liver and are of vital importance in the human body for energy generation in the heart and brain during fasting, exercise and severe illness. Ketosis can be safely obtained using dietary supplements and can increase exercise capacity in athletes. The most important ketone bodies are 3-hydroxybutyrate (3-OHB) and acetoacetate. Recently, it was demonstrated that patients with severe HF have increased myocardial utilization of the ketone body 3-hydroxybutyrate.

We have shown, using positron emission tomography, that ketone body infusion reduces myocardial glucose uptake and increases myocardial blood flow in healthy subjects. Data from another study conducted by our group show a 40% increase in cardiac output during infusion of 3-OHB.

Presently there are no data on the clinical cardiovascular and metabolic effects of long-term oral ketone-supplementation in patients with chronic HF.

In this study the investigators will whether ketosis obtained by oral ketone supplements affects hemodynamics and contractile function.

Conditions

Heart Failure; Ketosis; Ketonemia

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: CROSSOVER
• Primary Study Purpose: TREATMENT
• Blinding Strategy: DOUBLE

Study Groups

Single dose oral 3-hydroxybutyrate monoester

Cross-over study in 8 patients receiving single-dose oral 3-hydroxybutyrate monoester, 3-OHB salt and placebo.

Group Type: EXPERIMENTAL

Ketone Monoester

Intervention Type: DIETARY_SUPPLEMENT

Commercially available ketone monoester in a dosage isocaloric to 3-OHB salts.

Single dose oral 3-hydroxybutyrate Salt

Group Type: EXPERIMENTAL

Oral 3-hydroxybutyrate salts

Intervention Type: DIETARY_SUPPLEMENT

Comercially available 3-hydroxybutyrate salts with 36 grams of 3-OHB salts three times daily.

Single dose oral placebo

maltodextrin-based, isocaloric to ketone dosis.

Group Type: PLACEBO_COMPARATOR

Carbohydrate Placebo

Intervention Type: DIETARY_SUPPLEMENT

Comercially available carbohydrate sports drink. The placebo dose is isocaloric to the 3-hydroxy butyrate dose.

Interventions

Oral 3-hydroxybutyrate salts

Comercially available 3-hydroxybutyrate salts with 36 grams of 3-OHB salts three times daily.

Intervention Type: DIETARY_SUPPLEMENT

Carbohydrate Placebo

Comercially available carbohydrate sports drink. The placebo dose is isocaloric to the 3-hydroxy butyrate dose.

Intervention Type: DIETARY_SUPPLEMENT

Ketone Monoester

Commercially available ketone monoester in a dosage isocaloric to 3-OHB salts.

Intervention Type: DIETARY_SUPPLEMENT

Eligibility Criteria

Inclusion Criteria

• Chronic Heart Failure;
• NYHA class II-III
• Left Ventricular Ejection Fraction <40%

Exclusion Criteria

• Diabetes or HbA1c > 48 mmol/mol
• Significant cardiac valve disease,
• Severe stable angina pectoris
• Severe comorbidity as judged by investigator,
• Inability to give informed consent.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

University of Aarhus

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Kristian H Christensen, MD

Role: PRINCIPAL_INVESTIGATOR

Aarhus Universitetshospital - Department of Cardiology

Locations

Aarhus University Hospital

Aarhus, , Denmark

Countries

Denmark

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

KETO- CHF 1-10-72-362-18

Identifier Type: -

Identifier Source: org_study_id