HEART-FAILURE KETOSIS

Objective. To assess whether blood ketone bodies are increased in cong estive heart failure (CHF). Methods. Thirteen patients with CHF and 11 cardiac patients without CHF took part in the study. Blood acetoaceta te and b-hydroxybutyrate levels and the pertinent metabolic and hormon al milieu were measured during 20 h fast and after 2 h glucose infusio n. Results. The averaged blood ketone body and free fatty acid levels were significantly higher during the fast and also remained higher aft er glucose infusion in patients with CHF than in the control group. Th e areas under ketone body concentration time curve over the last 8 h o f the fast were 3522 +/- 662 mu mol L-1 h(-1)(SE) and 1789 +/- 192 mu mol L-1 h(-1) in patients with and without CHE respectively (P = 0.022 ). Circulating noradrenaline and growth hormone were higher but glucag on lower in patients with CHF than in the controls (P < 0.05 for all d ifferences) whereas the glucose and insulin concentrations were compar able in the study groups. At the time of peak ketonaemia, the glucagon -to-insulin ratio was lower in patients with CHF than in patients with out CHF (P = 0.04). Conclusions. These data suggest that severe CHF is a ketosis-prone state. Augmented supply of free fatty acids for ketog enesis due to increased stress hormone-related lipolysis is one likely mechanism.