Exhaled Acetone as a New Biomarker of Heart Failure Severity

Author(s)

Marcondes-Braga, Fabiana G. ^[1] ; Gutz, Ivano G. R. ^[2] ; Batista, Guilherme L. ^[2] ; Saldiva, Paulo H. N. ^[3] ; Ayub-Ferreira, Silvia M. ^[1] ; Issa, Victor S. ^[1] ; Mangini, Sandrigo ^[1] ; Bocchi, Edimar A. ^[1] ; Bacal, Fernando ^[1]

Affiliation

^[1] Univ Sao Paulo, Lab Heart Failure, Heart Inst InCor, Hosp Clin, Fac Med, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Inst Chem, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Sch Med, Lab Expt Air Pollut, Dept Pathol, Sao Paulo - Brazil

• Document type: Journal article
• Source: CHEST; v. 142, n. 2, p. 457-466, AUG 2012.
• Web of Science Citations: 35

Abstract

Background: Heart failure (HF) is associated with poor prognosis, and the identification of biomarkers of its severity could help in its treatment. In a pilot study, we observed high levels of acetone in the exhaled breath of patients with HF. The present study was designed to evaluate exhaled acetone as a biomarker of HF diagnosis and HF severity. Methods: Of 235 patients with systolic dysfunction evaluated between May 2009 and September 2010, 89 patients (HF group) fulfilled inclusion criteria and were compared with sex- and age-matched healthy subjects (control group, n = 20). Patients with HF were grouped according to clinical stability (acute decompensated HF {[}ADHF], n = 59; chronic HF, n = 30) and submitted to exhaled breath collection. Identification of chemical species was done by gas chromatography-mass spectrometry and quantification by spectrophotometry. Patients with diabetes were excluded. Results: The concentration of exhaled breath acetone (EBA) was higher in the HF group (median, 3.7 mu g/L; interquartile range {[}IQR], 1.69-10.45 mu g/L) than in the control group (median, 0.39 mu g/L; IQR, 0.30-0.79 mu g/L; P < .001) and higher in the ADHF group (median, 7.8 mu g/L; IQR, 3.6-15.2 mu g/L) than in the chronic HF group (median, 1.22 mu g/L; IQR, 0.68-2.19 P < .001). The accuracy and sensitivity of this method in the diagnosis of HF and ADHF were about 85%, a value similar to that obtained with B-type natriuretic peptide (BNP). EBA levels differed significantly as a function of severity of HF (New York Heart Association classification, P < .001). There was a positive correlation between EBA and BNP (r = 0.772, P < .001). Conclusions: EBA not only is a promising noninvasive diagnostic method of HF with an accuracy equivalent to BNP but also a new biomarker of HF severity. CHEST 2012; 142(2):457-466 (AU)

• FAPESP's process: 08/06620-2 - Detection of exhaled gas in heart failure patients: is that a new prognostic factor?
• Grantee: Fernando Bacal
• Support Opportunities: Regular Research Grants