NPPA and heart failure: Furthermore, several studies have revealed that ketone supplementation significantly improves the left ventricular ejection fraction in animals with myocardial infarction (MI) or heart failure and reduces ventricular mass, myocardial cell cross-sectional area, and atrial natriuretic peptide protein expression (Yurista et al., 2021a), which further demonstrates the protective role of ketone body metabolism on cardiac structure.