From Heart Failure to Highly Unsaturated Fatty Acid Deficiency and Vice Versa: Bidirectional Heart and Liver Interactions.
BACKGROUND
In several trials, beneficial prognostic effects of highly unsaturated fatty acids (HUFAs) in heart failure were shown. Because other studies showed no incremental benefit in nearly preserved cardiac function, the question arises, whether the degree of cardiac dysfunction is involved. It is hypothesized that increased left ventricular (LV) wall stress affects the endogenous hepatic HUFA metabolism, which in turn exhibits adverse cardiac consequences.


METHODS
Cardiac magnetic resonance imaging was performed in 30 patients with suspected cardiomyopathy. The serum fatty acid profile was assessed using gas chromatography/mass spectrometry.


RESULTS
Docosahexaenoic acid (DHA; P = 0.002) and eicosapentaenoic acid (EPA; by trend) levels were decreased in patients with reduced LV ejection fraction (≤ 50%) or LV dilatation (≥ 90 mL/m(2)). Decreased DHA (P = 0.003) and EPA (P = 0.022) levels were associated with a reduced LV ejection fraction. Decreased DHA level was correlated with increased end-diastolic (P = 0.047) and end-systolic LV wall stress (P = 0.001). Pseudocholinesterase activity was inversely correlated with end-diastolic (P = 0.020) and end-systolic LV wall stress (P = 0.025).


CONCLUSIONS
DHA level was significantly reduced in heart failure. Similar, but less pronounced effects were found for EPA and arachidonic acid by trend. Increased LV wall stress was correlated with a reduced DHA level. Increased LV wall stress exhibits various adverse consequences (eg, increased oxygen consumption, favouring of arrhythmias, and an unfavourable remodelling). The increase of wall stress was paralleled by reduced HUFA level. Increased LV wall stress was correlated with reduced pseudocholinesterase, which is suggestive of hepatic congestion (ie, a cardiohepatic syndrome, involved in the altered fatty acid profile in heart failure) and has major consequences regarding the dose-efficacy of HUFA treatment.
Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Marburg, Germany. Electronic address: alter@uni-marburg.de.
Peter
P
Alter
Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Marburg, Germany.
Tobias
T
Glück
Department of Radiology, University of Marburg, Marburg, Germany.
Jens H
JH
Figiel
Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Marburg, Germany.
A Rembert
AR
Koczulla
Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Marburg, Germany.
Claus F
CF
Vogelmeier
Department of Medicine, Pulmonary and Critical Care Medicine, University of Marburg, Marburg, Germany.
Heinz
H
Rupp
D005231:Fatty Acids, Unsaturated / Q000097:blood* / Q000172:deficiency; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000378:metabolism*; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008099:Liver / Q000378:metabolism*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D011379:Prognosis; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*
D005231:Fatty Acids, Unsaturated