Department of Chemistry and Industrial Chemistry, University of Pisa, Pisa, Italy.
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
J Breath Res. 2023 Aug 9;17(4). doi: 10.1088/1752-7163/acec08.
This paper describes the AEOLUS pilot study which combines breath analysis with cardiopulmonary exercise testing (CPET) and an echocardiographic examination for monitoring heart failure (HF) patients. Ten consecutive patients with a prior clinical diagnosis of HF with reduced left ventricular ejection fraction were prospectively enrolled together with 15 control patients with cardiovascular risk factors, including hypertension, type II diabetes or chronic ischemic heart disease. Breath samples were collected at rest and during CPET coupled with exercise stress echocardiography (CPET-ESE) protocol by means of needle trap micro-extraction and were analyzed through gas-chromatography coupled with mass spectrometry. The protocol also involved using of a selected ion flow tube mass spectrometer for a breath-by-breath isoprene and acetone analysis during exercise. At rest, HF patients showed increased breath levels of acetone and pentane, which are related to altered oxidation of fatty acids and oxidative stress, respectively. A significant positive correlation was observed between acetone and the gold standard biomarker NT-proBNP in plasma (= 0.646,< 0.001), both measured at rest. During exercise, some exhaled volatiles (e.g., isoprene) mirrored ventilatory and/or hemodynamic adaptation, whereas others (e.g., sulfide compounds and 3-hydroxy-2-butanone) depended on their origin. At peak effort, acetone levels in HF patients differed significantly from those of the control group, suggesting an altered myocardial and systemic metabolic adaptation to exercise for HF patients. These preliminary data suggest that concomitant acquisition of CPET-ESE and breath analysis is feasible and might provide additional clinical information on the metabolic maladaptation of HF patients to exercise. Such information may refine the identification of patients at higher risk of disease worsening.
本文描述了 AEOLUS 初步研究，该研究将呼吸分析与心肺运动测试（CPET）和超声心动图检查相结合，用于监测心力衰竭（HF）患者。连续纳入 10 例先前临床诊断为射血分数降低的心力衰竭患者，并前瞻性纳入 15 例具有心血管危险因素的对照患者，包括高血压、2 型糖尿病或慢性缺血性心脏病。通过针阱微萃取收集静息和 CPET 期间的呼吸样本，并通过气相色谱-质谱联用进行分析。该方案还涉及使用选定的离子流管质谱仪在运动过程中进行呼吸分析异戊二烯和丙酮。在静息时，HF 患者的呼吸丙酮和戊烷水平升高，分别与脂肪酸氧化改变和氧化应激有关。在静息时，观察到丙酮与血浆中的金标准生物标志物 NT-proBNP（= 0.646，< 0.001）之间存在显著正相关。在运动过程中，一些呼出的挥发性物质（例如异戊二烯）反映了通气和/或血液动力学的适应，而其他物质（例如硫化物化合物和 3-羟基-2-丁酮）则取决于它们的来源。在最大努力时，HF 患者的丙酮水平与对照组患者的丙酮水平显著不同，表明 HF 患者的心肌和全身代谢对运动的适应发生改变。这些初步数据表明，同时进行 CPET-ESE 和呼吸分析是可行的，并且可能为 HF 患者对运动的代谢适应不良提供额外的临床信息。这些信息可以更好地识别病情恶化风险较高的患者。
