title: Exhaled Acetone Concentration Is Related to Hemodynamic Severity in Patients With Non-Ischemic Chronic Heart Failure.
abstract: BACKGROUND
  We hypothesized that exhaled acetone concentration (EAC), reflecting altered blood ketone body metabolism and increased acetone exhaust because of pulmonary congestion in heart failure (HF), would correlate with hemodynamic parameters in patients with non-ischemic chronic HF.
  
  
  RESULTS
  We prospectively enrolled 102 non-ischemic HF patients with New York Heart Association (NYHA) class I-III. Exhaled breath was collected after an overnight fast. Echocardiography and cardiac catheterization were performed in all patients. We also enrolled 17 control patients without HF. EAC in the HF patients was significantly higher than that in the control patients (median EAC; 0.53 vs. 0.38 ppm, P=0.012). EAC positively correlated with blood total ketone bodies (r=0.454, P<0.001), NYHA class (r=0.489, P<0.001), and plasma B-type natriuretic peptide (r=0.316, P=0.001). Right heart catheterization revealed that EAC significantly correlated with pulmonary capillary wedge pressure (PCWP, r=0.377, P<0.001). Receiver-operating characteristic analysis revealed that EAC >1.05 ppm was associated with PCWP ≥18 mmHg (area under the curve [AUC] 0.726, sensitivity 50%, specificity 89%). EAC was shown to be a comparable diagnostic biomarker for HF to BNP (AUC 0.760, sensitivity 80%, specificity 70%).
  
  
  CONCLUSIONS
  EAC may be a novel noninvasive biomarker that correlates hemodynamic severity in non-ischemic chronic HF. (Circ J 2016; 80: 1178-1186).
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Yokokawa
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Sugano
authors.forename: Akito
authors.initials: A
authors.lastname: Shimouchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Shibata
authors.forename: Naoya
authors.initials: N
authors.lastname: Jinno
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nagai
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kanzaki
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aiba
authors.forename: Kengo
authors.initials: K
authors.lastname: Kusano
authors.forename: Mikiyasu
authors.initials: M
authors.lastname: Shirai
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Takeishi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yasuda
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.forename: Toshihisa
authors.initials: T
authors.lastname: Anzai
mesh_terms: D000096:Acetone / Q000032:analysis*; D015415:Biomarkers; D001944:Breath Tests / Q000379:methods; D016022:Case-Control Studies; D002908:Chronic Disease; D045853:Exhalation; D006333:Heart Failure / Q000175:diagnosis*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D000096:Acetone