Supplements · Diets
exogenous ketones improves cardiac output
In plain terms: Can drinking ketones help the heart pump better?
Leans support Supplements 🔬 Includes disconfirming
Part of: 🧪 exogenous ketones
RefutedContestedStrong support
consensus score 0.50
Yes in heart-failure patients, but trials are short, from one group, and measure performance not survival.
📅 Last reviewed: 2026-07-15 ⓘ
Evidence ladder
How far up the ladder this claim has climbed. A high consensus on a low rung means "consistent so far," not "proven in people."
Top evidence so far: All trials, pooled (Meta-analysis)
MechanismIn-vitroAnimalObservationalRCTMeta-analysis
How the studies fall
14 support 2 contradict 3 tested null 2 mixed · 21 sources, 16 independent groups · 1 superseded — pooled inside a review, counted once
What the evidence shows
Exogenous ketones acutely raise cardiac output and myocardial efficiency in heart failure (HCA2-mediated) - the best clinical ketone signal. But short-term, surrogate endpoints (not mortality), and essentially one research group (Aarhus).
The evidence (22)
| Source | Grade | Stance | Quality | Finding |
|---|---|---|---|---|
| Chevli 2026 · J Am Heart Assoc | observational | tested-null | low | UK Biobank: higher circulating ketone bodies associated with incident CV outcomes/mortality - endogenous KB are a stress marker, not a benefit signal |
| Horsdal 2025 · Basic Res Cardiol | animal | supports | high | Blinded crossover in porcine cardiogenic shock: 3-OHB increased cardiac output and contractility |
| Selvaraj 2025 · JACC Heart Fail | RCT | supports | moderate | [FT-verified] KETO-HFpEF 2025 crossover n=20 resting CO +0.6 L/min though peak VO2 null; independent group |
| Solis-Herrera 2025 · Diabetes | RCT | supports | high | Independent group: graded beta-OHB infusion dose-dependently raised cardiac output, LVEF and stroke volume in T2DM+HF; NaHCO3 control negative |
| Berg-Hansen K et al] # corrected 2026-08-17 from PubMed; was [(HFrEF 14-day) 2024 · (RCT) | RCT | supports | moderate | 14-day oral ketone-ester n=24 HFrEF resting CO 5.2 vs 5.0 L/min lower wedge pressure |
| Tominec D et al 2025 · study_type: RCT | RCT | contradicts | high | RCT, n=33 healthy adults (IEK n=16 vs placebo n=17), ketone monoester ingestion during high-altitude acclimatization; altitude increased cardiac output similarly in both groups (P=0.529-0.828) — no ketone effect on cardiac output. |
| Seto 2025 · Physiol Rep | RCT | tested-null | moderate | Independent crossover RCT in healthy young adults: acute ketone monoester did not change resting/stress HR, BP, blood flow or sympathetic activity |
| Lyhne 2025 · Intensive Care Med Exp | animal | tested-null | moderate | 3-OHB increased cardiac output and reduced pulmonary vascular resistance in porcine pulmonary embolism |
| Crabtree CD et al 2025 · study_type: RCT | observational | supports | moderate | Placebo-controlled acute cardiac MRI study, n=21 healthy adults (BH-BD n=11 vs placebo n=10); BH-BD raised R-BHB to 2.1mM, CO increased +31% (p<0.001) via +SV and +HR, myocardial blood flow +29%; placebo showed no change. |
| Siddiqi 2026 · World J Crit Care Med | meta-analysis | supports | moderate | SR/MA of RCTs: ketone-body supplementation improved cardiac output and LVEF in heart-failure patients (emerging, limited evidence) |
| Kodur N et al 2025 · study_type: observational | observational | supports | low | State-of-the-art narrative review: multiple small short-term clinical trials show exogenous ketone supplementation may improve myocardial function across HF manifestations, though long-term data lacking. |
| Aromiwura AA et al 2025 · study_type: observational | observational | supports | low | Narrative (non-systematic) review of myocardial perfusion regulation; concludes ketone bodies improve myocardial blood flow/ejection fraction in healthy subjects and beneficially affect cardiac output and filling pressures in decompensated |
| Seefeldt 2024 · Sci Rep | animal | mixed | moderate | 3-OHB raised cardiac output via stroke volume but caused inotropy-resistant vasoplegia in transplant |
| Sun Q et al 2025 · study_type: animal | animal | contradicts | moderate | Mouse HFpEF model; 6-week ketone ester (1,3-butanediol) or empagliflozin supplementation restored myocardial ketone oxidation rates but was NOT associated with improvement in cardiac function. |
| Challa AA et al 2025 · study_type: observational | observational | supports | moderate | Narrative review of ketone bodies' vascular effects; cites small clinical studies showing exogenous ketone administration to HF patients reduces systemic vascular resistance and improves myocardial function, plus increased coronary blood fl |
| Shrestha S et al 2026 · study_type: observational | observational | supports | moderate | Narrative review of ketone biology in cardiovascular health/disease; discusses ketones' effects on cardiac metabolic/structural remodeling and signaling (beta-hydroxybutyrylation), citing preclinical and early clinical benefit in HF. |
| Mohib 2025 · Nutrients | RCT | supports | moderate | Systematic review: exogenous ketosis acutely improved hemodynamics/cardiac output among the most consistent clinical benefits in disease |
| Crabtree CD et al 2025 · study_type: observational | observational | supports | low | Narrative review: nutritional ketosis acutely elevates cardiac output and myocardial perfusion in healthy and CVD subjects in a dose-dependent manner; effect durable up to 14 days; no long-term studies performed. |
| Gupta A et al 2026 · medRxiv | meta-analysis | supports | high | Systematic review + random-effects meta-analysis of 8 RCTs (oral ketones/infusions vs placebo) in HF/cardiometabolic-risk adults. Exogenous ketones increased CO (MD +1.11 L/min, 95%CI 0.55-1.67), LVEF, and SV, decreased PCWP. |
| Nielsen R, et al. 2019 · Circulation | RCT | supports | moderate | Landmark crossover n=16 HFrEF 3-OHB raised CO +2.0 L/min P<.001 via SV+HR; LVEF +8% acute ↩ SUPERSEDED — pooled in the review above, counted once |
| Gouwens 2025 · Circ Res | animal | mixed | moderate | Independent group: enhancing cardiac ketone-body oxidation improved exercise performance/cardiac function in mice |
| Bech 2025 · Sci Rep | animal | supports | moderate | Hyperpolarized-MRS pig study: beta-3-OHB infusion increased cardiac output (1.9 to 3.8 L/min) and heart rate |
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