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We examined whether the cardiovascular effects of ketone bodies are different in patients with type 1 diabetes (T1D) compared with healthy control individuals. In a single-blind study with a crossover design, nine patients with T1D and eight age-matched, healthy control study participants were randomized to receive a 3-h infusion of 3-hydroxybutyrate (3-OHB) or tonicity-matched saline in random order, separated by a 1-h washout period. Assessor-blinded echocardiographic evaluation of cardiovascular function was performed at baseline and after 150 min of each intervention. Circulating 3-OHB increased during 3-OHB infusion versus placebo in healthy control participants, with a similar increase in patients with T1D. In the control group, 3-OHB infusion increased cardiac output by 1.9 \u00b1 0.4 L\/min (means \u00b1 SE) but only by 0.5 \u00b1 0.1 L\/min in patients with T1D. Stroke volume increased by 14 \u00b1 5 mL and left ventricular (LV) ejection fraction by 3 \u00b1 1 percentage points in healthy control participants; there was no change in these parameters in patients with T1D. During 3-OHB infusion in patients with T1D, LV global wasted work increased and LV global work efficiency decreased. In conclusion, patients with T1D had an abnormal cardiovascular response to 3-OHB infusion. Diabetic cardiomyopathy in patients may involve impaired cardiac ketone metabolism.<\/jats:p>\n                  <jats:sec>\n                    <jats:title>ARTICLE HIGHLIGHTS<\/jats:title>\n                    <jats:p>The diabetic heart has reduced ketone utilization due to impaired ketolytic enzyme activity. In a randomized controlled crossover trial, we investigated whether the cardiac response to 3-hydroxybutyrate infusion is impaired in type 1 diabetes. The response on cardiac output was blunted by 80% in type 1 diabetes, with no improvement in systolic function and left ventricular work efficiency was reduced. These findings suggest impaired cardiac ketone metabolism may have clinical significance and could contribute to diabetic cardiomyopathy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/db25-0243","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T12:26:01Z","timestamp":1750163161000},"page":"1643-1651","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":3,"title":["The Cardiac and Hemodynamic Effects of Ketone Bodies Are Abnormal in Patients With Type 1 Diabetes: A Randomized Controlled Trial"],"prefix":"10.2337","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5110-0656","authenticated-orcid":false,"given":"Kristoffer","family":"Berg-Hansen","sequence":"first","affiliation":[{"name":"Department of Cardiology, Aarhus University Hospital 1 , Aarhus, Denmark"},{"name":"Department of Clinical Medicine, Faculty of Health, Aarhus University 2 , Aarhus, 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