Diagnostic and Prognostic Value of Metabolomics in Heart Failure | Journal Scan

Apr 16, 2015
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Authors:
Cheng ML, Wang CH, Shiao MS, et al.
Citation:
Metabolic Disturbances Identified in Plasma Are Associated With Outcomes in Patients With Heart Failure: Diagnostic and Prognostic Value of Metabolomics. J Am Coll Cardiol 2015;65:1509-1520.
Summary By:
Ragavendra R. Baliga, MBBS, FACC

Study Questions:

What is the diagnostic and prognostic value of metabolomics in heart failure (HF)?

Methods:

The study cohort was comprised of 515 participants. The participants were enrolled in three groups:

  1. The discovery phase group: 183 HF patients and 51 normal controls
  2. The validation study group: 218 stage C HF patients (those patients who were hospitalized due to acute or decompensated HF and aged 20-85 years) and 63 controls
  3. The “recovery” group: 32 stage C HF patients who had recovered to New York Heart Association functional class I at 6 and 12 months

The investigators performed mass spectrometry-based profiling of plasma metabolites on the study participants.

Results:

When using untargeted analysis, the investigators found that amino acids and phospholipids were important discriminators of normal controls and stage C HF patients. Among these, a panel of metabolites—particularly histidine, phenylalanine, spermidine, and phosphatidylcholine C34:4—was similar to B-type natriuretic peptide (BNP) in diagnostic value. They also found that the values of this panel improved significantly at 6 and 12 months in the recovery group. A combination of four metabolic components comprised of methylarginine/arginine ratio, butyrylcarnitine, spermidine, and total amount of essential amino acids provided significant prognostic values (p < 0.0001) independent of BNP and traditional risk factors. The prognostic value of this panel of four metabolites was better than that of BNP (area under the curve of 0.85 vs. 0.74 for BNP) and Kaplan-Meier curves (log rank = 17.5 vs. 9.95). The investigators were able to verify these findings in the validation group.

Conclusions:

The authors concluded that a profile of metabolites provides better prognostic value than conventional biomarkers such as BNP.

Perspective:

This is an important study because it demonstrates a correlation between advanced HF and important products of cellular metabolism. Important principles to consider when evaluating and applying the results of biomarker studies include: 1) Are the results valid? 2) What are the results? 3) Will the results help me in caring for my patients? The next step would be to confirm in large studies whether this panel of metabolites is useful in diagnosis, in risk stratification, for titration of therapy, and in the detection of preclinical HF. If indeed, the findings of this study are corroborated in large cohorts, then metabolomics should emerge as powerful tools in the management of HF.

Keywords: Amino Acids, Amino Acids, Essential, Arginine, Biomarkers, Carnitine, Heart Failure, Histidine, Mass Spectrometry, Metabolic Syndrome, Metabolomics, Natriuretic Peptide, Brain, Phenylalanine, Phosphatidylcholines, Phospholipids, Risk, Risk Factors, Spermidine


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