Metabolomics and a Breath Sensor Identify Acetone as a Biomarker for Heart Failure

Biomolecules. 2022 Dec 21;13(1):13. doi: 10.3390/biom13010013.

Abstract

Background: Multi-omics delivers more biological insight than targeted investigations. We applied multi-omics to patients with heart failure with reduced ejection fraction (HFrEF).

Methods: 46 patients with HFrEF and 20 controls underwent metabolomic profiling, including liquid/gas chromatography mass spectrometry (LC-MS/GC-MS) and solid-phase microextraction (SPME) volatilomics in plasma and urine. HFrEF was defined using left ventricular global longitudinal strain, ejection fraction and NTproBNP. A consumer breath acetone (BrACE) sensor validated results in n = 73.

Results: 28 metabolites were identified by GCMS, 35 by LCMS and 4 volatiles by SPME in plasma and urine. Alanine, aspartate and glutamate, citric acid cycle, arginine biosynthesis, glyoxylate and dicarboxylate metabolism were altered in HFrEF. Plasma acetone correlated with NT-proBNP (r = 0.59, 95% CI 0.4 to 0.7), 2-oxovaleric and cis-aconitic acid, involved with ketone metabolism and mitochondrial energetics. BrACE > 1.5 ppm discriminated HF from other cardiac pathology (AUC 0.8, 95% CI 0.61 to 0.92, p < 0.0001).

Conclusion: Breath acetone discriminated HFrEF from other cardiac pathology using a consumer sensor, but was not cardiac specific.

Keywords: heart failure with reduced ejection fraction.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetone
  • Biomarkers / metabolism
  • Heart Failure*
  • Humans
  • Metabolomics
  • Stroke Volume

Substances

  • Acetone
  • Biomarkers

Grants and funding

Grants from the Health Research Council of New Zealand Explorer Grant 16/680. PA Gladding and W Hewitt are cofounders and hold equity in HeartLab AI, a startup company focused on echocardiography artificial intelligence. T Schlegel is the founder and holds equity in Nicollier-Schlegel Sàrl, a provider of advanced ECG services. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.