Aromiwura Afolasayo A, Gouwens Kara R, Nguyen Daniel C, Sztukowska Maryta, Didelot Luanne, Kalra Dinesh K
Division of Cardiology, Department of Medicine, University of Louisville, Louisville, KY 40202, USA.
Department of Medicine, Christina Lee Brown Envirome Institute, Center for Cardiometabolic Science, University of Louisville, Louisville, KY 40202, USA.
Int J Mol Sci. 2025 May 19;26(10):4856. doi: 10.3390/ijms26104856.
Ketone bodies (KBs) serve as an alternative energy source for healthy and failing hearts and have important effects on myocardial blood perfusion in both physiological and pathological states. Early animal studies suggest that KBs may provide protective benefits in ischemic heart disease and heart failure. Under normal circumstances, coronary blood flow regulation is an intricate system with contributions from metabolic, autonomic, compressive, and endothelial factors, with the metabolic regulatory pathway being the most significant contributor. We conducted a non-systematic review of studies published between 1987 and 2024. In this review, we explored the physiological autoregulation of normal coronary blood flow, the role of ketone bodies in myocardial perfusion in health and disease, and the potential role of exogenous ketone body supplementation in producing salutary effects on myocardial blood flow (MBF) and metabolism in exercise and cardiac disease states including ischemia, heart failure, and the aging heart. Overall, our findings demonstrated that KBs improve MBF and ejection fraction in healthy human subjects and have beneficial effects on cardiac output and left heart filling pressures in patients with decompensated heart failure. Although resting myocardial blood flow decreases with age, further studies are required to assess the impact of KBs on MBF in aging populations. Additionally, more research is needed to investigate the effects of KBs during exercise and in instances of myocardial ischemia.
酮体（KBs）是健康心脏和衰竭心脏的替代能源，在生理和病理状态下对心肌血流均有重要影响。早期动物研究表明，酮体可能对缺血性心脏病和心力衰竭具有保护作用。在正常情况下，冠状动脉血流调节是一个复杂的系统，涉及代谢、自主神经、压迫和内皮等多种因素，其中代谢调节途径是最重要的因素。我们对1987年至2024年发表的研究进行了非系统性综述。在本综述中，我们探讨了正常冠状动脉血流的生理自动调节、酮体在健康和疾病状态下心肌灌注中的作用，以及外源性补充酮体对运动和包括缺血、心力衰竭及老年心脏等心脏疾病状态下心肌血流（MBF）和代谢产生有益影响的潜在作用。总体而言，我们的研究结果表明，酮体可改善健康人体受试者的心肌血流和射血分数，并对失代偿性心力衰竭患者的心输出量和左心充盈压产生有益影响。尽管静息心肌血流会随着年龄增长而减少，但仍需要进一步研究来评估酮体对老年人群心肌血流的影响。此外，还需要更多研究来探究酮体在运动期间和心肌缺血情况下的作用。
