Metabolic Disturbances Identified in Plasma Are Associated With Outcomes in Patients With Heart Failure Diagnostic and Prognostic Value of Metabolomics
Metabolic Disturbances Identified in Plasma Are Associated With Outcomes in Patients With Heart Failure Diagnostic and Prognostic Value of Metabolomics
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DOI：
10.1016/j.jacc.2015.02.018
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发表时间：
2015-04-21
影响因子：
24
通讯作者：
Yang, Ning-I
中科院分区：
文献类型：
--
作者：
Cheng, Mei-Ling;Wang, Chao-Hung;Yang, Ning-I
需要对新生物标志物的背景识别来改善心力衰竭的诊断和预后（HF）。 Obigntives患者中的代谢障碍非常明显，该研究试图评估HF的代谢组学对诊断和预后值的诊断和预后值。Methods在515名参与者中进行了基于血浆代谢物的基于质谱的分析；发现阶段研究招募了51名正常对照组和183名HF患者，验证研究招募了63名对照组和218例C期CHF患者。另一个独立的组为32例C期CHF患者，在6和12个月中恢复到纽约心脏协会I级功能I级功能为“恢复”组。将一组代谢物（包括组氨酸，苯丙氨酸，精子和磷脂酰胆碱C34）组成。 ：4，具有类似于B型纳地钠肽（BNP）的诊断值。在恢复组中，该小组的值在6和12个月时显着提高。为了评估预后价值，事件定义为死亡或与HF相关的重新住院的终点。一个代谢物面板由不对称的甲基亚氨酸/精氨酸比率，丁酰基苯胺，精子和必需氨基酸的总量组成，提供了与BNP和传统风险因素无关的预后值（P <0.0001）。代谢物面板的预后值优于BNP（BNP曲线下的面积为0.85 vs. 0.74）和Kaplan-Meier曲线（log Cank：17.5 vs. 9.95）。这些发现在验证研究中得到了证实。结论代谢组学在估计与HF相关的代谢障碍时表现出强大的诊断价值。代谢物的特征提供了更好的预后价值与常规生物标志物。 （c）2015年美国心脏病学院基金会。
BACKGROUND Identification of novel biomarkers is needed to improve the diagnosis and prognosis of heart failure (HF). Metabolic disturbance is remarkable in patients with HF.OBJECTIVES This study sought to assess the diagnostic and prognostic values of metabolomics in HF.METHODS Mass spectrometry-based profiling of plasma metabolites was performed in 515 participants; the discovery phase study enrolled 51 normal control subjects and 183 HF patients, and the validation study enrolled 63 control subjects and 218 patients with stage C HF. Another independent group of 32 patients with stage C HF who recovered to New York Heart Association functional class I at 6 and 12 months was profiled as the "recovery" group.RESULTS A panel of metabolites, including histidine, phenylalanine, spermidine, and phosphatidylcholine C34:4, has a diagnostic value similar to B-type natriuretic peptide (BNP). In the recovery group, the values of this panel significantly improved at 6 and 12 months. To evaluate the prognostic values, events were defined as the combined endpoints of death or HF-related re-hospitalization. A metabolite panel, which consisted of the asymmetric methylarginine/arginine ratio, butyrylcarnitine, spermidine, and the total amount of essential amino acids, provided significant prognostic values (p < 0.0001) independent of BNP and traditional risk factors. The prognostic value of the metabolite panel 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). These findings were corroborated in the validation study.CONCLUSIONS Metabolomics demonstrate powerful diagnostic value in estimating HF-related metabolic disturbance. The profile of metabolites provides better prognostic value versus conventional biomarkers. (C) 2015 by the American College of Cardiology Foundation.