Acute Oral Ketones or Carbohydrate Supplement Modify Heart Function in Heart Failure?

Does oral intake of exogenous ketone salt improve heart function measured by cardiac MRI in heart failure compared to oral intake of a carbohydrate placebo?

Inclusion Criteria:Patients with heart failure with left ventricle ejection fraction of 40%Heart failure of ischemic or dilated etiologyAmbulatory patient with a NYHA functional class of II-III;Stable symptoms and no change in medical therapy in the last month.Exclusion Criteria:DiabetesPatients treated with any SGLT2i;Chronic kidney diseaseAcute coronary syndrome in the last 3 months;Use of parenteral inotropic agents;Persistent or permanent atrial fibrillation or atrial flutter;Presence of pacemaker or defibrillator;Medical condition that causes malabsorption of the test material;Under ketogenic diet, or using exogenous ketone supplementsUse of nicotinamide adenine dinucleotide (NAD) precursor supplements