Prognostic Implications of Long-Chain Acylcarnitines in Heart Failure and Reversibility With Mechanical Circulatory Support

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• 作者：Tariq Ahmad ; MD ; MPH^&lowast ; ; ^&dagger ; ; ^{tariq.ahmad@yale.edu" class="auth_mail" title="E-mail the corresponding author} ; Jacob P. Kelly ; MD^&dagger ; ; ^&Dagger ; ; Robert W. McGarrah ; MD^&dagger ; ; ^&sect ; ; Anne S. Hellkamp ; PhD^&Dagger ; ; Mona Fiuzat ; PharmD^&Dagger ; ; Jeffrey M. Testani ; MD ; MTR^&lowast ; ; Teresa S. Wang ; MD^‖ ; Amanda Verma ; MD^&dagger ; ; Marc D. Samsky ; MD^&dagger ; ; Mark P. Donahue ; MD^&dagger ; ; Olga R. Ilkayeva ; PhD^&sect ; ; Dawn E. Bowles ; PhD^¶ ; ; Chetan B. Patel ; MD^&dagger ; ; ^&Dagger ; ; Carmelo A. Milano ; MD^¶ ; ; Joseph G. Rogers ; MD^&dagger ; ; ^&Dagger ; ; G. Michael Felker ; MD ; MHS^&dagger ; ; ^&Dagger ; ; Christopher M. O&rsquo ; Connor ; MD^&Dagger ; ; ^# ; Svati H. Shah ; MD ; MPH^&dagger ; ; ^&sect ; ; William E. Kraus ; MD^&dagger ; ; ^&sect ;
• 关键词：metabolomics ; phenotypes ; prognosis
• 刊名：Journal of the American College of Cardiology
• 出版年：2016
• 出版时间：26 January 2016
• 年：2016
• 卷：67
• 期：3
• 页码：291-299
• 全文大小：1114 K

文摘

Heart failure (HF) is characterized by perturbations in energy homeostasis and metabolism. The reversibility and prognostic value of circulating markers associated with these changes remain unclear.

ec_2">Objectives

This study sought to describe the metabolomic profiles of patients along the spectrum of systolic HF, determine their association with adverse outcomes in a clinical trial of HF, and evaluate whether identified metabolites change with treatment for end-stage systolic HF.

ec_3">Methods

To assess association of metabolites with clinical outcomes, we evaluated a population of 453 chronic systolic HF patients who had been randomized to exercise training versus usual care. To assess change in metabolites with mechanical circulatory support, 41 patients with end-stage HF who underwent left ventricular assist device (LVAD) placement were studied. Targeted, quantitative profiling of 60 metabolites using tandem flow injection mass spectrometry was performed on frozen plasma samples obtained prior to randomization, as well as prior to and ≥90 days post-placement in the LVAD group. Principal components analysis was used for data reduction.

ec_4">Results

Five principal components analysis–derived factors were significantly associated with peak Vo₂ levels at baseline in fully adjusted models. Of these, factor 5 (composed of long-chain acylcarnitines) was associated with increased risk of all 3 pre-specified clinical trial outcomes: all-cause mortality/all-cause hospitalization, all cause-hospitalization, and cardiovascular death or cardiovascular hospitalization. Individual components of factor 5 were significantly higher in patients with end-stage HF prior to LVAD placement and decreased significantly post-implantation.

ec_5">Conclusions

In chronic HF patients, circulating long-chain acylcarnitine metabolite levels were independently associated with adverse clinical outcomes and decreased after long-term mechanical circulatory support. These metabolites may serve as potential targets for new diagnostics or therapeutic interventions. (Exercise Training Program to Improve Clinical Outcomes in Individuals With Congestive Heart Failure; ef0010" class="interref" data-locatorType="https" data-locatorKey="//clinicaltrials.gov/ct2/show/NCT00047437">NCT00047437)