Breath acetone changes in decompensated heart failure patients on inotropes.

Abstract

Early assessment of treatment response in patients with decompensated heart failure (HF) requiring inotropic support remains challenging. Exhaled breath acetone, a noninvasive marker of ketone body metabolism, may reflect dynamic metabolic changes associated with clinical status. We aimed to evaluate short-term temporal changes in exhaled breath acetone levels following inotropic therapy in patients with decompensated HF. This is a prospective, single-center observational study including patients with HF requiring inotropic therapy. Exhaled breath acetone levels were measured in decompensated HF patients requiring inotropic support using a previously described noninvasive device at hospital admission and within 48 h. The analysis was performed by spectrophotometry after reaction with salicylaldehyde. Ninety-seven patients were enrolled. Baseline median exhaled breath acetone concentration at admission was 7.75 (3.90-12.27)µg l^-1and decreased to 2.15 (1.10-4.19)µg l^-1after 48 h of inotrope initiation (p< 0.001 for within-patient comparison). This reduction was accompanied by clinical improvement in signs of HF decompensation and occurred in patients with or without type 2 diabetes, although the magnitude of this reduction was greater in patients without diabetes (p= 0.001). Elevated exhaled breath acetone levels were observed in patients with decompensated HF and decreased after initiation of inotropic therapy, paralleling clinical improvement. These findings are hypothesis-generating and larger prospective studies may confirm the potential role of exhaled breath acetone in clinical decision-making.