Ketone body metabolism in diabetic and non-diabetic heart failure

Heart failure (HF) is one of the most common cardiovascular diseases, causing large disease and economic burden worldwide. Impaired metabolic balance has been confirmed as a significant aspect of HF, and alteration of substrate utilization plays a vital role in the development of HF. Diabetes mellitus is strictly related with HF, and patients with diabetes show a higher mortality and morbidity of HF. Furthermore, HF patients and animals with diabetes behave different characteristics of metabolic pattern and substrate utilization comparing to those without diabetes. Recently, ketone body has been demonstrated as an alternative energy source in HF, which may improve myocardial energy supply and thus be adaptive for HF. Studies measured ketone body oxidation and production of ketone body metabolism in different groups of patients and animal models. This review focuses on the alteration of ketone body metabolism during HF and compares different results between diabetic and non-diabetic HF and the potential mechanism.