Altered Metabolic Profile With Sodium-Restricted Dietary Approaches to Stop Hypertension Diet in Hypertensive Heart Failure With Preserved Ejection Fraction.
BACKGROUND
Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized as a distinct entity with unique pathophysiology. In the Dietary Approaches to Stop Hypertension in Diastolic Heart Failure (DASH-DHF) study, the sodium-restricted Dietary Approaches to Stop Hypertension diet (DASH/SRD) was associated with improved blood pressure and cardiovascular function in 13 hypertensive patients with HFpEF. With the use of targeted metabolomics, we explored metabolite changes and their relationship with energy-dependent measures of cardiac function in DASH-DHF.


RESULTS
With the use of chromatography and mass spectrometry, 152 metabolites including amino acids, free fatty acids, phospholipids, diglycerides, triglycerides, cholesterol esters, and acyl carnitines were measured. Comparison of baseline and post-DASH/SRD samples revealed increases in short-chain acetyl, butryl, and propionyl carnitines (P values .02, .03, .03, respectively). Increases in propionyl carnitine correlated with ventricular-arterial coupling ratio (Ees:Ea; r = 0.78; P = .005) and ventricular contractility (maximum rate of change of pressure-normalized stress [dσ*/dtmax]; r = 0.66; P = .03). Changes in L-carnitine also correlated with Ees:Ea (r = 0.62; P = .04) and dσ*/dtmax (r = 0.60; P = .05) and inversely with ventricular stiffness (r = -0.63; P = .03).


CONCLUSIONS
Metabolite profile changes of patients with HFpEF during dietary modification with the use of DASH/SRD suggest improved energy substrate utilization. Additional studies are needed to clarify connections between diet, metabolic changes, and myocardial function in HFpEF.
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Anna V
AV
Mathew
Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
E Mitchell
EM
Seymour
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Jaeman
J
Byun
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan.
Subramaniam
S
Pennathur
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan. Electronic address: scothumm@med.umich.edu.
Scott L
SL
Hummel
D000328:Adult; D017677:Age Distribution; D000368:Aged; D002845:Chromatography / Q000379:methods; D004039:Diet, Sodium-Restricted; D015150:Echocardiography, Doppler; D005260:Female; D054144:Heart Failure, Diastolic / Q000097:blood* / Q000000981:diagnostic imaging / Q000178:diet therapy* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000178:diet therapy* / Q000453:epidemiology / Q000503:physiopathology; D015994:Incidence; D008297:Male; D013058:Mass Spectrometry / Q000379:methods; D055442:Metabolome / Q000502:physiology*; D008875:Middle Aged; D010865:Pilot Projects; D011379:Prognosis; D018570:Risk Assessment; D012494:Sampling Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D013318:Stroke Volume / Q000502:physiology*
DASH diet; Heart failure with preserved ejection fraction; low-sodium diet; metabolomics