Plasma Amino Acid Abnormalities in Chronic Heart Failure. Mechanisms, Potential Risks and Targets in Human Myocardium Metabolism

Abstract

The goal of this study was to measure arterial amino acid levels in patients with chronic heart failure (CHF), and relate them to left ventricular function and disease severity. Amino acids (AAs) play a crucial role for heart protein-energy metabolism. In heart failure, arterial AAs, which are the major determinant of AA uptake by the myocardium, are rarely measured. Forty-one subjects with clinically stable CHF (New York Heart Association (NYHA) class II to IV) were analyzed. After overnight fasting, blood samples from the radial artery were taken to measure AA concentrations. Calorie (KcalI), protein-, fat-, carbohydrate-intake, resting energy expenditure (REE), total daily energy expenditure (REE × 1.3), and cardiac right catheterization variables were all measured. Eight matched controls were compared for all measurements, with the exception of cardiac catheterization. Compared with controls, CHF patients had reduced arterial AA levels, of which both their number and reduced rates are related to Heart Failure (HF) severity. Arterial aspartic acid correlated with stroke volume index (r = 0.6263; p < 0.0001) and cardiac index (r = 0.4243; p = 0.0028). The value of arterial aspartic acid (µmol/L) multiplied by the cardiac index was associated with left ventricular ejection fraction (r = 0.3765; p = 0.0076). All NYHA groups had adequate protein intake (≥1.1 g/kg/day) and inadequate calorie intake (KcalI < REE × 1.3) was found only in class IV patients. This study showed that CHF patients had reduced arterial AA levels directly related to clinical disease severity and left ventricular dysfunction.

Association of Serum Amino Acid Concentration With Loss of Skeletal Muscle Mass After 1 Year in Cardiac Rehabilitation Center Patients

“…body needs and the serum BCAA concentration was significantly lower than in healthy controls. 13 In the present study, lymphocyte count, hemoglobin, albumin, total cholesterol, and CONUT score, which are widely used for evaluating nutritional status, were not associated with decreased SMI. Hemoglobin and albumin have been shown to be associated with skeletal muscle mass, 3,14 but those studies showed the association at the same observation point and did not refer to the association with future changes in skeletal muscle mass.…”

Differences in Amino Acid Loss Between High-Efficiency Hemodialysis and Postdilution and Predilution Hemodiafiltration Using High Convection Volume Exchange—A New Metabolic Scenario? A Pilot Study

“…Data obtained from this sample of patients were compared, and statistical differences were evaluated with the findings of a study conducted on a group of 8 healthy volunteers. 19,20 Dry weight and target weight were calculated on the basis of both intradialytic and extradialytic clinical assessment and on total body water values determined by means of bioimpedance analysis.…”

“…The AA concentration was expressed in both micromol/L and in mg/dl and compared in our laboratory with standard values; data obtained in these studies were subsequently compared statistically using the same laboratory procedure with those of 8 healthy volunteers in whom AA arterial concentrations had been determined. 19,21 Twenty AAs were determined, although analysis was limited to total AAs (TAAs), essential AAs (EAAs) including branched chain AAs (BCAAs), nonessential AAs (NEAAs), and the ratio of all classes of AA/TAAs.…”

“…The second aim of the study was to investigate whether over time AA changes may result in metabolic and nutritional decline in patients subjected to these methods of dialysis. Finally, a subanalysis was performed to compare plasma AA concentrations measured in arterial blood between healthy controls 19,20 and long-term dialysis patients.…”

Amino Acid Imbalance in Atherosclerosis

“…The human heart uses a large number of free amino acids) as regulators of both myocardial protein metabolism and energy metabolism [41]. The dependence of the myocardium on the amino acid fund of the heart increases with heart failure due to the high activity of the anabolic in the myocardium and the lack of energy for cardiomyocytes.…”