Identification of Metabolomics Profile in Elderly Patients at the End Stage of Heart Failure.

Background: With an increase in the aging population, heart failure (HF) has become a major healthcare problem. Therefore, early detection of key signals characteristic of each of the stages of HF has the potential to improve treatment and palliative care. Metabolomics profiling may be useful in identifying biomarkers of HF and improving HF treatment.

Methods and results: This study was a retrospective subanalysis of the CURE-HF registry, a prospective observational study of patients with acute decompensated HF. Patients were divided into 3 groups: those who died within 3 months of discharge due to cardiovascular disease (CVD), those who died within 3-6 months of discharge due to CVD, and those who survived >2 years as a control group. Serum samples from 28 patients (median age 85 years [interquartile range 74-90 years]; 11 (39.3%) women) were subjected to capillary electrophoresis time-of-flight mass spectrometry. Partial least-squares (PLS) discriminant analysis showed a negative correlation between carnitine and short-term mortality (R=-0.508, P=0.006). Urea (R=-0.597, P<0.001) and symmetric dimethylarginine (R=-0.634, P<0.001) were negatively correlated with survival, while tryptophan was positively correlated with survival (R=0.548, P=0.003).

Conclusions: Carnitine, symmetric dimethylarginine, urea, and tryptophan appear to be critical biomarkers for monitoring terminal stages in HF. Our results suggest that myocardial energy metabolism and renal dysfunction are associated with changes in the metabolome.