Exogenous ketone supplementation significantly improved multiple cardiac function markers in a meta-analysis of 8 randomized controlled trials. Ketone therapy increased left ventricular ejection fraction by 3.94%, cardiac output by 1.11 L/min, and stroke volume by 10.21 mL, while reducing harmful pulmonary capillary wedge pressure by 0.93 mmHg. These metabolic interventions harness the heart's preferential shift toward ketone metabolism during stress states, potentially offering a novel therapeutic pathway for cardiovascular disease. The findings align with emerging research on ketones as alternative fuel sources that may be more efficient than glucose for compromised cardiac muscle. However, the analysis included only 8 studies from 565 screened records, suggesting limited available data in this emerging field. The heterogeneity of patient populations—ranging from heart failure to diabetes and hypertension—also raises questions about optimal patient selection. As this systematic review awaits peer review, the promising cardiac benefits warrant cautious optimism. This represents confirmatory evidence supporting ketone therapy's potential, though larger, longer-term trials are needed to establish clinical protocols and safety profiles for routine cardiac care.