title: Impact of Exhaled Breath Acetone in the Prognosis of Patients with Heart Failure with Reduced Ejection Fraction (HFrEF). One Year of Clinical Follow-up.
abstract: BACKGROUND
  The identification of new biomarkers of heart failure (HF) could help in its treatment. Previously, our group studied 89 patients with HF and showed that exhaled breath acetone (EBA) is a new noninvasive biomarker of HF diagnosis. However, there is no data about the relevance of EBA as a biomarker of prognosis.
  
  
  OBJECTIVE
  To evaluate whether EBA could give prognostic information in patients with heart failure with reduced ejection fraction (HFrEF).
  
  
  METHODS
  After breath collection and analysis by gas chromatography-mass spectrometry and by spectrophotometry, the 89 patients referred before were followed by one year. Study physicians, blind to the results of cardiac biomarker testing, ascertained vital status of each study participant at 12 months.
  
  
  RESULTS
  The composite endpoint death and heart transplantation (HT) were observed in 35 patients (39.3%): 29 patients (32.6%) died and 6 (6.7%) were submitted to HT within 12 months after study enrollment. High levels of EBA (≥3.7μg/L, 50th percentile) were associated with a progressively worse prognosis in 12-month follow-up (log-rank = 11.06, p = 0.001). Concentrations of EBA above 3.7μg/L increased the risk of death or HT in 3.26 times (HR = 3.26, 95%CI = 1.56-6.80, p = 0.002) within 12 months. In a multivariable cox regression model, the independent predictors of all-cause mortality were systolic blood pressure, respiratory rate and EBA levels.
  
  
  CONCLUSIONS
  High EBA levels could be associated to poor prognosis in HFrEF patients.
authors.affiliation: Department of Heart Transplant, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil Av. Dr Eneas de Carvalho Aguiar, 44 - 2°. andar.
authors.forename: Fabiana G
authors.initials: FG
authors.lastname: Marcondes-Braga
authors.affiliation: Chemistry Institute, University of São Paulo, Sao Paulo, Brazil Av.Prof. Lineu Prestes, 748, bloco 12, sala 1270-Cidade Universitária.
authors.forename: Guilherme L
authors.initials: GL
authors.lastname: Batista
authors.affiliation: Chemistry Institute, University of São Paulo, Sao Paulo, Brazil Av.Prof. Lineu Prestes, 748, bloco 12, sala 1270-Cidade Universitária.
authors.forename: Ivano G R
authors.initials: IG
authors.lastname: Gutz
authors.affiliation: Department of Pathology, Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil Av. Dr. Arnaldo, 455, 1° andar.
authors.forename: Paulo H N
authors.initials: PH
authors.lastname: Saldiva
authors.affiliation: Department of Heart Transplant, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil Av. Dr Eneas de Carvalho Aguiar, 44 - 2°. andar.
authors.forename: Sandrigo
authors.initials: S
authors.lastname: Mangini
authors.affiliation: Department of Heart Failure, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Victor S
authors.initials: VS
authors.lastname: Issa
authors.affiliation: Department of Heart Failure, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Silvia M
authors.initials: SM
authors.lastname: Ayub-Ferreira
authors.affiliation: Department of Heart Failure, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil.
authors.forename: Edimar A
authors.initials: EA
authors.lastname: Bocchi
authors.affiliation: Laboratory of Genetics and Molecular Cardiology, Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil Av.Dr. Eneas de Carvalho Aguiar, 44-10°. andar.
authors.forename: Alexandre Costa
authors.initials: AC
authors.lastname: Pereira
authors.affiliation: Department of Heart Transplant, Heart Institute (InCor), do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil Av. Dr Eneas de Carvalho Aguiar, 44 - 2°. andar.
authors.forename: Fernando
authors.initials: F
authors.lastname: Bacal
mesh_terms: D000096:Acetone / Q000378:metabolism*; D000328:Adult; D001944:Breath Tests; D045853:Exhalation; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000175:diagnosis* / Q000378:metabolism* / Q000401:mortality / Q000601:surgery; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D000096:Acetone