Abstract 14631: Increased Cardiac Uptake of Ketone Bodies and Free Fatty Acids in Human Heart Failure and Hypertrophic Left Ventricular Remodeling

Deranged fuel supply and energy metabolism contribute to the pathophysiology of heart failure. Recent animal studies showed diminished free fatty acid (FFA) oxidation in experimental heart failure models with a shift towards oxidation of ketone bodies. However, conflicting clinical data on FFA metabolism and limited knowledge on ketone body metabolism in the failing human heart mandate additional metabolic profiling studies. We therefore investigated cardiac uptake of FFA’s, lactate, glucose, and ketone bodies (3-OH-butyrate, 3-OHB and acetoacetate, AcAc) in patients with heart failure with reduced ejection fraction (HFrEF, LVEF <35%) or with aortic stenosis (AS, mean AVA = 0.73±0.18 cm2)-induced LV hypertrophy. We hypothesized that FFA oxidation is impaired in HFrEF and in AS and results in decreased concentrations of free carnitine, the necessary carrier for mitochondrial entry of activated FFA’s, and in accumulation of metabolic intermediates. We collected arterial and coronary sinus blood samples in p...