{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T10:43:19Z","timestamp":1780396999137,"version":"3.54.1"},"reference-count":56,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T00:00:00Z","timestamp":1768176000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Internal Research Fund of Gansu Provincial People\u2019s Hospital","award":["24GSSYE-15"],"award-info":[{"award-number":["24GSSYE-15"]}]},{"name":"Graduate Innovation and Entrepreneurship Program of Gansu University of Chinese Medicine","award":["2025CXZX-917"],"award-info":[{"award-number":["2025CXZX-917"]}]},{"name":"Major Collaborative Project of the Gansu Provincial Department of Science and Technology","award":["24JRRA886"],"award-info":[{"award-number":["24JRRA886"]}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["8246020036"],"award-info":[{"award-number":["8246020036"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Gansu Provincial People\u2019s Hospital Excellent Doctoral Training Program","award":["22GSSYD-14"],"award-info":[{"award-number":["22GSSYD-14"]}]},{"name":"Quality Standard of Xanthoceras sorbifolia Bunge in Gansu Province and Prospective Multicenter Randomized Controlled Clinical Study on Treatment of Metabolic Syndrome","award":["GZKZ-2021-7"],"award-info":[{"award-number":["GZKZ-2021-7"]}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging. Given the critical role of metabolic disturbance and energy expenditure in HFpEF pathophysiology, we investigated the clinical significance and diagnostic value of blood ketone bodies in these patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This case\u2013control study enrolled 160 participants, comprising 80 HFpEF patients and 80 matched healthy controls. Baseline characteristics, levels of blood ketones (acetoacetate, \u03b2-hydroxybutyrate, acetone), and NT-proBNP were compared. Multivariate linear regression and correlation analyses were employed to assess the associations between ketone levels, clinical parameters, and NT-proBNP. The diagnostic performance was evaluated using receiver operating characteristic (ROC) curve analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to controls, HFpEF patients showed significant differences in age, heart rate, BMI, and blood pressure. Multivariate regression revealed a significant linear association between BMI, systolic blood pressure, and acetoacetate levels in the HFpEF group. A weak inverse correlation was found between acetoacetate and NT-proBNP levels. However, no correlation was observed between ketone levels and NYHA functional class. ROC analysis demonstrated that the combination of acetoacetate and NT-proBNP yielded the highest diagnostic efficacy (AUC\u202f=\u202f0.9117), superior to NT-proBNP alone (AUC\u202f=\u202f0.8328) or any ketone body alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Unlike nutritional ketosis, elevated blood ketone levels in patients with HFpEF likely reflect impaired metabolic efficiency rather than a marker of cardiac function. Nevertheless, this phenomenon has diagnostic significance: combining acetoacetate with NT-proBNP can markedly improve diagnostic performance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2025.1678905","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T05:41:55Z","timestamp":1768196515000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Potential causes and significance of elevated blood ketone levels in patients with heart failure with preserved ejection 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