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Original Research |

Exhaled Acetone as a New Biomarker of Heart Failure SeverityExhaled Acetone and Heart Failure

Fabiana G. Marcondes-Braga, MD, PhD; Ivano G. R. Gutz, PhD; Guilherme L. Batista, MSc; Paulo H. N. Saldiva, MD, PhD; Silvia M. Ayub-Ferreira, MD, PhD; Victor S. Issa, MD, PhD; Sandrigo Mangini, MD; Edimar A Bocchi, MD, PhD; Fernando Bacal, MD, PhD
Author and Funding Information

From the Laboratory of Heart Failure (Drs Marcondes-Braga, Ayub-Ferreira, Issa, Mangini, Bocchi, and Bacal), Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo; Chemistry Institute (Dr Gutz and Mr Batista), University of São Paulo; and Laboratory of Experimental Air Pollution (Dr Saldiva), Department of Pathology, University of São Paulo Medical School, São Paulo, Brazil.

Correspondence to: Fabiana G. Marcondes-Braga, MD, PhD, Av Dr Eneas de Carvalho Aguiar, 44 1° andar bloco 1, Laboratório de Insuficiência Cardíaca, Cerqueira Cesar, São Paulo CEP 05403-000, Brazil; e-mail: fgmarcondes@yahoo.com.br


Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.

Funding/Support: This work was supported by a grant from Fundação de Amparo à Pesquisa do Estado de São Paulo [FAPESP grant number 08/06620-2]. Fellowships from Conselho Nacional do Desenvolvimento Científico e Tecnológico are acknowledged by Dr Gutz and Mr Batista.


Chest. 2012;142(2):457-466. doi:10.1378/chest.11-2892
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Background:  Heart failure (HF) is associated with poor prognosis, and the identification of biomarkers of its severity could help in its treatment. In a pilot study, we observed high levels of acetone in the exhaled breath of patients with HF. The present study was designed to evaluate exhaled acetone as a biomarker of HF diagnosis and HF severity.

Methods:  Of 235 patients with systolic dysfunction evaluated between May 2009 and September 2010, 89 patients (HF group) fulfilled inclusion criteria and were compared with sex- and age-matched healthy subjects (control group, n = 20). Patients with HF were grouped according to clinical stability (acute decompensated HF [ADHF], n = 59; chronic HF, n = 30) and submitted to exhaled breath collection. Identification of chemical species was done by gas chromatography-mass spectrometry and quantification by spectrophotometry. Patients with diabetes were excluded.

Results:  The concentration of exhaled breath acetone (EBA) was higher in the HF group (median, 3.7 μg/L; interquartile range [IQR], 1.69-10.45 μg/L) than in the control group (median, 0.39 μg/L; IQR, 0.30-0.79 μg/L; P < .001) and higher in the ADHF group (median, 7.8 μg/L; IQR, 3.6-15.2 μg/L) than in the chronic HF group (median, 1.22 μg/L; IQR, 0.68-2.19 μg/L; P < .001). The accuracy and sensitivity of this method in the diagnosis of HF and ADHF were about 85%, a value similar to that obtained with B-type natriuretic peptide (BNP). EBA levels differed significantly as a function of severity of HF (New York Heart Association classification, P < .001). There was a positive correlation between EBA and BNP (r = 0.772, P < .001).

Conclusions:  EBA not only is a promising noninvasive diagnostic method of HF with an accuracy equivalent to BNP but also a new biomarker of HF severity.

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