Can metabolomics reflect the hemodynamic profile at rest and during exercise of patients with HFrEF?
A Ntalianis, I Dotsikas, G Velissaris, C Kourek, O Simou, S Gyftopoulos, L Karatzanos, A Tasoulis, M Pentaris, D Chatzis, N Biagkis, E Panagiotopoulos, M Zagkli, S Tomaras, K BratisAbstract
Background
A maladaptive metabolic shift is observed in patients with HFrEF characterized by reduced fatty acid oxidation which results in lower ATP production and decreased contractility and function. Theoretically, the higher the extent of maladaptive metabolic shift the worse the left ventricular performance both at rest and during exercise.
Purpose
To seek for possible associations between metabolomics and hemodynamics during exercise right heart catheterization (ERHC) in patients with HFrEF.
Methods
Consecutive symptomatic patients with HFrEF submitted to ERHC were prospectively recruited. ERHC was performed via the right jugular vein with a 7F Swan-Ganz catheter. A controlled exercise protocol with a supine cycle ergometer to obtain hemodynamics and blood for gas analysis during exercise was then applied. Peripheral venous blood samples before exercise were systematically analyzed to determine several metabolites such as acylcarnitines,carbohydrates and amino acids. To identify possible correlations between metabolomics and hemodynamics linear regression analysis and a multiparametric model adjusted for age, gender and body mass index were used.
Results
Thirty two patients with HFrEF (mean age of 69±4y with a mean left ventricular ejection fraction of 27±10%) were finally included for analysis. A positive correlation between pulmonary capillary wedge pressure (PCWP) and acylcarnitine (C) 12 was found. Furthermore, mean right atrial pressure at rest was inversely associated with C0, C2, C5-OH, C16:1, C18:1 and C4DC. Finally, the pulmonary artery saturation at rest was positively associated with C14:1 (table). C12, C18:1 and glycine could reliably predict a high PCWP at rest (>15 mmHg) (figure).
Conclusions
Metabolomics can reflect the hemodynamic profile both at rest and during exercise of patients with HFrEF.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.