Single Exhaled Breath Metabolomic Analysis Identifies Unique Breathprint in Patients With Acute Decompensated Heart Failure

Study Questions:

What is the utility of single exhaled breath metabolomics analysis in identifying patients with acute decompensated heart failure (ADHF)?


The investigators conducted a prospective, single-center cohort study to assess the feasibility of exhaled breath analysis to identify patients admitted for ADHF. They recruited 25 consecutive patients admitted with ADHF as their primary diagnosis and a control group of 16 subjects admitted with non-ADHF cardiovascular diagnoses and who had no clinical evidence of systemic or venous congestion at the time of enrollment. Exhaled breath samples were collected within 24 hours of hospital admission and following an 8-hour fast and before the administration of morning pharmacotherapy.


The investigators observed increased exhaled acetone (median [interquartile range]: 811 [256-1974] ppb vs. 187 [115-572] ppb, p = 0.01) and pentane (40 [20-74] ppb vs. 22 [14-36] ppb, p = 0.03) levels in ADHF versus control groups. In addition, mass scanning of ion products for H3O+, O2+, and NO+ from 14 to 200 atomic mass units was performed, and stepwise variable selection was used to identify five ion peaks that were incorporated into a canonical discriminant analysis model that successfully distinguished ADHF from control patients (-2 log likelihood 0.038; Wilks’ Lambda 0.102 [p < 0.0001]). This “breathprint” was then tested in an independent validation cohort of 36 consecutive ADHF subjects with identical enrollment criteria to the derivation cohort. The discriminant analysis model correctly classified all subjects with no misclassifications.


The authors concluded that the study demonstrates the feasibility of single exhaled breath analysis in ADHF.


This pilot study demonstrates the feasibility of single exhaled breath analysis in ADHF and validated the previously reported alterations in acetone and pentane volatile organic compound (VOC) concentrations in ADHF. The study also provides evidence to support the hypothesis that a unique ADHF breathprint exists using selected ion-flow tube mass-spectrometry technology. Once a specific VOC or panel of VOCs is identified, highly sensitive and specific solid-state sensors can then be integrated into portable detectors. Future larger-scale prospective studies in exhaled breath metabolomics are needed to validate these results.

Clinical Topics: Heart Failure and Cardiomyopathies, Vascular Medicine, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: Pentanes, Spectrum Analysis, Exhalation, Metabolomics, Hyperemia, Discriminant Analysis, Heart Diseases, Breath Tests, Biological Markers, Troponin I, Heart Failure, Mass Spectrometry

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