Exhaled breath acetone as a biomarker of heart failure diagnosis in diabetic patients

• Grant number: 16/13299-2
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Effective date (Start): January 01, 2017
• Effective date (End): December 31, 2017
• Field of knowledge: Health Sciences - Medicine - Medical Clinics
• Principal Investigator: Fabiana Goulart Marcondes Braga
• Grantee: João Espínola Pessoa Pinto Filho
• Host Institution: Instituto do Coração Professor Euryclides de Jesus Zerbini (INCOR). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil

Abstract

Heart failure (HF) diagnosis is based on clinical criteria. However, considering other different comorbidities that are frequent in HF patients, the diagnosis is not so easy. Natriuretic peptides have been used to improve the accuracy of the diagnosis of HF. The stimulus for B-type natriuretic peptide (BNP) release is a change in left-ventricular wall stretch and volume overload. Regarding this property of BNP, it has been considered a good biomarker of HF diagnosis and prognosis. However, the development of new biomarkers could be of great interest considering the high mortality of this disease. In 2012, Marcondes-Braga et al described a new noninvasive biomarker of HF. The authors showed that HF patients had high levels of acetone in exhaled breath, especially when congestive symptoms were present. In this first study, diabetic patients were not included to avoid potential biases, since they can produce ketone bodies (acetoacetate and hydroxybutyrate in urine or acetone in blood or in breath). The aim of the current study is to evaluate the accuracy of exhaled breath acetone (EBA) for the diagnosis of HF in diabetic patients. It will be also analyzed the correlation between EBA and BNP in diabetic patients. This is a case-control study. We will compare levels of EBA in diabetic patients with HF (CASE) and diabetic patients without HF (CONTROL). Patients with HF will be selected from the cohort of GENIUS study (Genetic and Electronic Medical Records to Predict Outcomes in Heart Failure Patients) ¹ and patients who do not have HF will be selected from different clinics in Heart Institute. We will evaluate 69 patients in each arm (sample size calculated based on previous study 2 - statistical power 80%, p = 0.05). The exhaled breath analysis will be performed by spectrophotometry in Chemistry Institute of University of Sao Paulo. This is a well-known method used to determine different substances in exhaled breath, especially acetone. The comparison between the two groups will be performed after acetone collection and analysis.1 Gioli-Pereira L et al. BMC Cardiov Dis 2014,14:32. 2 Marcondes-Braga FG, et al. CHEST2012;142(2):457-466. (AU)