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Here, we test the hypothesis in rats that 3-OHB acts directly on the heart to increase cardiac contractility and directly on blood vessels to lower systemic vascular resistance. We investigate effects of 3-OHB on (a) in vivo hemodynamics using echocardiography and invasive blood pressure measurements, (b) isolated perfused hearts in Langendorff systems, and (c) isolated arteries and veins in isometric myographs. We compare Na-3-OHB to equimolar NaCl added to physiological buffers or injection solutions. At plasma concentrations of 2\u20134 mM in vivo, 3-OHB increases cardiac output (by 28.3\u00b17.8%), stroke volume (by 22.4\u00b16.0%), left ventricular ejection fraction (by 13.3\u00b14.6%), and arterial dP\/dt<jats:sub>max<\/jats:sub> (by 31.9\u00b111.2%) and lowers systemic vascular resistance (by 30.6\u00b111.2%) without substantially affecting heart rate or blood pressure. Applied to isolated perfused hearts at 3\u201310 mM, 3-OHB increases left ventricular developed pressure by up to 26.3\u00b17.4 mmHg and coronary perfusion by up to 20.2\u00b19.5%. Beginning at 1\u20133 mM, 3-OHB relaxes isolated coronary (EC<jats:sub>50<\/jats:sub>=12.4 mM), cerebral, femoral, mesenteric, and renal arteries as well as brachial, femoral, and mesenteric veins by up to 60% of pre-contraction within the pathophysiological concentration range. Of the two enantiomers that constitute racemic 3-OHB, D-3-OHB dominates endogenously; but tested separately, the enantiomers induce similar vasorelaxation. We conclude that increased cardiac contractility and generalized systemic vasorelaxation can explain the elevated cardiac output during 3-OHB administration. These actions strengthen the therapeutic rationale for 3-OHB in heart failure management.<\/jats:p>","DOI":"10.1007\/s00395-023-01008-y","type":"journal-article","created":{"date-parts":[[2023,9,9]],"date-time":"2023-09-09T06:01:45Z","timestamp":1694239305000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Ketone body 3-hydroxybutyrate elevates cardiac output through peripheral vasorelaxation and enhanced cardiac contractility"],"prefix":"10.1007","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8618-8109","authenticated-orcid":false,"given":"Casper","family":"Homilius","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0633-5878","authenticated-orcid":false,"given":"Jacob Marthinsen","family":"Seefeldt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1221-0115","authenticated-orcid":false,"given":"Julie S\u00f8rensen","family":"Axelsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7950-4647","authenticated-orcid":false,"given":"Tina Myhre","family":"Pedersen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-0185-5289","authenticated-orcid":false,"given":"Trine Monberg","family":"S\u00f8rensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9228-3869","authenticated-orcid":false,"given":"Roni","family":"Nielsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9753-4142","authenticated-orcid":false,"given":"Henrik","family":"Wiggers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4115-2858","authenticated-orcid":false,"given":"Jakob","family":"Hansen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3303-1095","authenticated-orcid":false,"given":"Vladimir V.","family":"Matchkov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6358-8962","authenticated-orcid":false,"given":"Hans Erik","family":"B\u00f8tker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5078-9279","authenticated-orcid":false,"given":"Ebbe","family":"Boedtkjer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,9,9]]},"reference":[{"key":"1008_CR1","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1002\/ejhf.1557","volume":"21","author":"T Ahmad","year":"2019","unstructured":"Ahmad T, Miller PE, McCullough M, Desai NR, Riello R, Psotka M, Bohm M, Allen LA, Teerlink JR, Rosano GMC, Lindenfeld J (2019) Why has positive inotropy failed in chronic heart failure? 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