Document Type

Letter to the Editor

Publication Date


Publication Title

Journal of The American College of Cardiology


Acute decompensated heart failure (ADHF) is the most common indication for hospital admission, particularly in the elderly, yet the identification of those with impending decompensation using conventional clinical methods is unreliable and frequently leaves insufficient lag time for therapeutic interventions (1). Exhaled breath constitutes a complex mixture of hundreds of volatile organic compounds (VOCs) that could potentially be used as a safe and noninvasive method of diagnostic and therapeutic monitoring (2). Previous research studies have identified elevated acetone, pentane, and nitric oxide levels in exhaled breath in the setting of HF correlated with disease severity (3–5). Selected ion-flow tube mass-spectrometry (SIFT-MS) combines a fast flow tube technique with quantitative mass spectrometry that is ideally suited for exhaled breath analysis because it allows for the analysis of small and humid samples without the need for cumbersome sample preparation or calibration (6). Scan times are relatively brief, thus facilitating high throughput and serial comparisons. Using this technology, we conducted a prospective, single-center cohort study to assess the feasibility of exhaled breath analysis to identify patients admitted for ADHF. The study protocol was approved by the Cleveland Clinic Institutional Review Board. We recruited 25 consecutive patients admitted with ADHF as their primary diagnosis (mean left ventricular ejection fraction 27 ± 13%, median N-terminal pro–B-type natriuretic peptide level 954 pg/ml) and a control group of 16 subjects admitted with non-ADHF cardiovascular diagnoses and who had no clinical evidence of systemic or venous congestion at the time of enrollment. Indications for hospitalization in the control group included unstable angina or non–ST-segment elevation myocardial infarction (6 of 16), conduction disorders (3 of 16), hypertensive emergency (3 of 16), atrial tachyarrhythmia (2 of 16), or stable angina (2 of 16). All analyses were performed using JMP Pro 9.0 (SAS Institute, Cary, North Carolina). As expected, there were significant (p < 0.01) baseline differences in the frequency of hypertension (54% vs. 100%) and baseline estimated glomerular filtration rate (68 ± 43 ml/min/1.73 m2 vs. 102 ± 44 ml/min/1.73 m2), which were significantly worse in the ADHF versus control group. Nevertheless, there were no significant differences between groups in age, body mass index, or several comorbidities (i.e., diabetes mellitus, chronic obstructive pulmonary disease, active smoking) theorized to result in alterations in the exhaled metabolome.


This research is supported by BRCP 08-049 Third Frontier Program grant from the Ohio Department of Development (Dr. Dweik), and National Institutes of Health grants R01HL103931 (Dr. Tang) and P20HL113452 (Dr. Tang), HL107147 (Dr. Dweik), HL081064 (Dr. Dweik), HL103453 (Dr. Dweik), HL109250 (Dr. Dweik), and RR026231 (Dr. Dweik).









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