Change of Exhaled Acetone Concentration Levels in Patients with Acute Decompensated Heart Failure

Yokokawa, Tetsuro; Sato, Toshio; Suzuki, Satoshi; Oikawa, Masayoshi; Yoshihisa, Akiomi; Kobayashi, Atsushi; Yamaki, Takashi; Kunii, Hiroyuki; Nakazato, Kazuhiko; Suzuki, Hitoshi; Saitoh, Shu‐ichi; Ishida, Takafumi; Shimouchi, Akito; Takeishi, Yasuchika

doi:10.1536/ihj.17-482

Cited by 22 publications

(23 citation statements)

References 14 publications

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“… 62 Many methods are used to detect elevated ketone body levels, such as blood, urine, and exhaled acetone concentrations in the breath of HF patients. 115 116 117 118 119 120 …”

Section: The Physiological Role Of Ketone Bodies In the Heartmentioning

confidence: 99%

SGLT2 Inhibitors and Ketone Metabolism in Heart Failure

Saucedo-Orozco

Voorrips

Yurista

et al. 2022

J Lipid Atheroscler

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Sodium-glucose cotransporter-2 (SGLT2) inhibitors have emerged as powerful drugs that can be used to treat heart failure (HF) patients, both with preserved and reduced ejection fraction and in the presence or absence of type 2 diabetes. While the mechanisms underlying the salutary effects of SGLT2 inhibitors have not been fully elucidated, there is clear evidence for a beneficial metabolic effect of these drugs. In this review, we discuss the effects of SGLT2 inhibitors on cardiac energy provision secondary to ketone bodies, pathological ventricular remodeling, and inflammation in patients with HF. While the specific contribution of ketone bodies to the pleiotropic cardiovascular benefits of SGLT2 inhibitors requires further clarification, ketone bodies themselves may also be used as a therapy for HF.

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“… 62 Many methods are used to detect elevated ketone body levels, such as blood, urine, and exhaled acetone concentrations in the breath of HF patients. 115 116 117 118 119 120 …”

Section: The Physiological Role Of Ketone Bodies In the Heartmentioning

confidence: 99%

SGLT2 Inhibitors and Ketone Metabolism in Heart Failure

Saucedo-Orozco

Voorrips

Yurista

et al. 2022

J Lipid Atheroscler

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“…In scientific studies, subjects with HF have 2–20‐fold greater levels of the ketone body acetone in breath (BrAce, Table 1) as compared to healthy controls (BrAce ∼ 1 ppm) or to cardiac patients without HF 23,25,26 . Increases (decreases) in BrAce correspond to increased (decreased) HF severity 23,24,47 . Thus, monitoring BrAC may provide a marker of HF deterioration or improvement 24,48 …”

Section: Ketosis From Diseasementioning

confidence: 99%

Measuring ketone bodies for the monitoring of pathologic and therapeutic ketosis

Anderson

Mattar

Greenway

et al. 2021

Obesity Science & Practice

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Background The ketone bodies β‐hydroxybutyrate (BOHB) and acetone are generated as a byproduct of the fat metabolism process. In healthy individuals, ketone body levels are ∼0.1 mM for BOHB and ∼1 part per million for breath acetone (BrAce). These levels can increase dramatically as a consequence of a disease process or when used therapeutically for disease treatment. For example, increased ketone body concentration during weight loss is an indication of elevated fat metabolism. Ketone body measurement is relatively inexpensive and can provide metabolic insights to help guide disease management and optimize weight loss. Methods This review of the literature provides metabolic mechanisms and typical concentration ranges of ketone bodies, which can give new insights into these conditions and rationale for measuring ketone bodies. Results Diseases such as heart failure and ketoacidosis can affect caloric intake and macronutrient management, which can elevate BOHB 30‐fold and BrAce 1000‐fold. Other diseases associated with obesity, such as brain dysfunction, cancer, and diabetes, may cause dysfunction because of an inability to use glucose, excessive reliance on glucose, or poor insulin signaling. Elevating ketone body concentrations (e.g., nutritional ketosis) may improve these conditions by forcing utilization of ketone bodies, in place of glucose, for fuel. During weight loss, monitoring ketone body concentration can demonstrate program compliance and can be used to optimize the weight‐loss plan. Conclusions The role of ketone bodies in states of pathologic and therapeutic ketosis indicates that accurate measurement and monitoring of BOHB or BrAce will likely improve disease management. Bariatric surgery is examined as a case study for monitoring both types of ketosis.

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“…Heart failure (HF) represents the final common pathway of different cardiac diseases and is a major cause of death among the elderly in many countries (1)(2)(3)(4). Currently, risk management and treatment of HF mainly depend on current left ventricular ejection fraction (LVEF) in clinical practice (5,6).…”

Section: Introductionmentioning

confidence: 99%

Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

Zhang

Sun

Chen

et al. 2021

Front. Cardiovasc. Med.

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Aims: Evidence-based guidelines for heart failure management depend mainly on current left ventricular ejection fraction (LVEF). However, fewer studies have examined the impact of prior LVEF. Patients may enter the heart failure with midrange ejection fraction (HFmrEF) category when heart failure with preserved ejection fraction (HFpEF) deteriorates or heart failure with reduced ejection fraction (HFrEF) improves. In this study, we examined the association between change in LVEF and adverse outcomes.Methods: HFmrEF patients with at least two or more echocardiograms 3 months apart at the First Affiliated Hospital of Dalian Medical University between September 1, 2015 and November 30, 2019 were identified. According to the prior LVEF, the subjects were divided into improved group (prior LVEF < 40%), stable group (prior LVEF between 40 and 50%), and deteriorated group (prior LVEF ≥ 50%). The primary outcomes were cardiovascular death, all-cause mortality, hospitalization for worsening heart failure, and composite event of all-cause mortality or all-cause hospitalization.Results: A total of 1,168 HFmrEF patients (67.04% male, mean age 63.60 ± 12.18 years) were included. The percentages of improved, stable, and deteriorated group were 310 (26.54%), 334 (28.60%), and 524 (44.86%), respectively. After a period of follow-up, 208 patients (17.81%) died and 500 patients met the composite endpoint. The rates of all-cause mortality were 35 (11.29%), 55 (16.47%), and 118 (22.52%), and the composite outcome was 102 (32.90%), 145 (43.41%), and 253 (48.28%) for the improved, stable, and deteriorated groups, respectively. Cox regression analysis showed that the deterioration group had higher risk of cardiovascular death (HR: 1.707, 95% CI: 1.064–2.739, P = 0.027), all-cause death (HR 1.948, 95% CI 1.335–2.840, P = 0.001), and composite outcome (HR 1.379, 95% CI 1.096–1.736, P = 0.006) compared to the improvement group. The association still remained significant after fully adjusted for both all-cause mortality (HR = 1.899, 95% CI 1.247–2.893, P = 0.003) and composite outcome (HR: 1.324, 95% CI: 1.020–1.718, P = 0.035).Conclusion: HFmrEF patients are heterogeneous with three different subsets identified, each with different outcomes. Strategies for managing HFmrEF should include previously measured LVEF to allow stratification based on direction changes in LVEF to better optimize treatment.

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Change of Exhaled Acetone Concentration Levels in Patients with Acute Decompensated Heart Failure

Cited by 22 publications

References 14 publications

SGLT2 Inhibitors and Ketone Metabolism in Heart Failure

SGLT2 Inhibitors and Ketone Metabolism in Heart Failure

Measuring ketone bodies for the monitoring of pathologic and therapeutic ketosis

Heart Failure With Midrange Ejection Fraction: Prior Left Ventricular Ejection Fraction and Prognosis

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