Exhaled breath acetone: a non-invasive marker of disease severity across the spectrum of heart failure
Year: 2025
Type: article
Study design: Observational Study
Abstract: Background. Increased exhaled breath acetone (EBA) concentrations might reflect impaired myocardial energetics and haemodynamic stress. We investigated the relation of EBA and cardiac structure, function, and exercise capacity in patients with or at risk of heart failure (HF). Methods. We enrolled outpatients with HF and reduced (<50%, HFrEF) or preserved (>50%, HFpEF) left ventricular ejection fraction (LVEF) and subjects with cardiovascular risk factors and/or structural heart disease without established HF. All participants underwent clinical and laboratory evaluation, resting transthoracic echocardiography, and a combined cardiopulmonary-echocardiographic stress test with EBA monitoring at rest (EBA rest ) and during exercise (EBA ex ). Results. Patients with HFpEF ( n = 62) were older and more often female than those at risk of HF ( n = 50) or with HFrEF ( n = 41). EBA rest (1.5, interquartile range (IQR) 1.0–3.1 vs 0.9, IQR 0.7–1.2 mcg l −1 ) and EBA ex (2.4, IQR 1.5–4.4 vs 1.1, IQR 0.9–2.1 mcg l −1 ; all p < 0.0001) were significantly higher in patients with HF compared to others. Among HF patients, those in the highest EBA rest tertile had lower LVEF, greater echocardiographic signs of congestion, higher NT-proBNP levels, and lower peak oxygen consumption, indicating impaired exercise capacity. In multivariate regression, NT-proBNP ( p = 0.0004) and the slope of minute ventilation to carbon dioxide production ( p = 0.0013) were independent predictors of EBA rest (adjusted R 2 = 0.458). Conclusions. EBA concentrations are higher in patients with HF compared to those without, regardless of LVEF, and are associated with markers of disease severity. Further studies are needed to determine whether EBA measurement can aid in HF diagnosis and management.
Source: Journal of Breath Research
Authors: Nicolò De Biase, Silvia Ghimenti, Lavinia Del Punta, Denise Biagini, Alessio Lenzi, Fabio Di Francesco, Stefano Taddei, Pierpaolo Pellicori, Stefano Masi, Tommaso Lomonaco, Nicola Riccardo Pugliese
Institutions: University of Pisa, University of Glasgow
Language: English
Subfield: Biomedical Engineering
Field: Engineering
Domain: Physical Sciences
Open Access status: green
OpenAlex ID: W4415638904