PDF(Pubmed)
Abstract：
Exhaled breath volatile organic compounds (VOCs) are elevated in heart failure (HF). The ability of VOCs to predict long term cardiovascular mortality and morbidity has not been independently verified. In 55 patients admitted with acute decompensated heart failure (ADHF), we measured exhaled breath acetone and pentane levels upon admission and after 48 h of diuresis. In a separate cohort of 51 cardiac patients undergoing cardiopulmonary exercise testing (CPET), we measured exhaled breath acetone and pentane levels before and at peak exercise. In the ADHF cohort, admission acetone levels correlated with lower left ventricular ejection fraction (LVEF, r = -0.297, p = 0.035). Greater weight loss with diuretic therapy correlated with a greater reduction in both acetone levels (r = -0.398, p = 0.003) and pentane levels (r = -0.309, p = 0.021). In patients with above-median weight loss (≥4.5 kg), patients demonstrated significantly greater percentage reduction in acetone (59% reduction vs. 7% increase, p < 0.001) and pentane (23% reduction vs. 2% reduction, p = 0.008). In the CPET cohort, admission acetone and pentane levels correlated with higher VE/VCO2 (r = 0.39, p = 0.005), (r = 0.035, p = 0.014). However, there were no significant correlations between baseline or peak exercise acetone and pentane levels and peak VO2. In longitudinal follow-up with a median duration of 33 months, patients with elevated exhaled acetone and pentane levels experienced higher composite adverse events of death, ventricular assist device implantation, or orthotopic heart transplantation. In patients admitted with ADHF, higher exhaled breath acetone levels are associated with lower LVEF and poorer outcomes, and greater reductions in exhaled breath acetone and pentane tracked with greater weight loss. Exhaled acetone and pentane may be novel biomarkers in heart failure worthy of future investigation.
摘要：
呼气挥发性有机化合物(VOC)在心力衰竭(HF)中升高。VOCs预测长期心血管死亡率和发病率的能力尚未得到独立验证。在55例急性失代偿性心力衰竭（ADHF）患者中，我们测量了入院时和利尿48小时后的呼气丙酮和戊烷水平。在接受心肺运动试验（CPET）的51名心脏病患者的单独队列中，我们测量了运动前和运动高峰期的呼气丙酮和戊烷水平。在ADHF队列中，入院丙酮水平与左心室射血分数降低相关(LVEF，r=-0.297，p=0.035）。利尿剂治疗的体重减轻与丙酮水平（r=-0.398，p=0.003）和戊烷水平（r=-0.309，p=0.021）的降低有关。在体重减轻超过中位数（≥4.5kg）的患者中，患者显示丙酮减少的百分比显着增加（减少59％vs.7%的增长，p<0.001）和戊烷（减少23%与减少2%,p=0.008)。在CPET队列中，入院丙酮和戊烷水平与较高的VE/VCO2相关（r=0.39，p=0.005），(r=0.035,p=0.014)。然而,基线或峰值运动丙酮和戊烷水平与峰值VO2之间没有显着相关性。在纵向随访中，中位持续时间为33个月，呼出的丙酮和戊烷水平升高的患者经历了更高的死亡复合不良事件，心室辅助装置植入,或者原位心脏移植.在ADHF患者中，较高的呼气丙酮水平与较低的LVEF和较差的结局相关，呼出气丙酮和戊烷的减少幅度更大，体重减轻更大。呼出丙酮和戊烷可能是心力衰竭的新型生物标志物，值得未来研究。
