Circulating beta-hydroxybutyrate levels in advanced heart failure with reduced ejection fraction: determinants and prognostic impact

Result code in IS VaVaI

<a href="https://www.isvavai.cz/riv?ss=detail&h=RIV%2F00023001%3A_____%2F24%3A00085050" target="_blank" >RIV/00023001:_____/24:00085050 - isvavai.cz</a>

Result on the web

<a href="https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3324" target="_blank" >https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3324</a>

DOI - Digital Object Identifier

<a href="http://dx.doi.org/10.1002/ejhf.3324" target="_blank" >10.1002/ejhf.3324</a>

Result language

angličtina

Original language name

Circulating beta-hydroxybutyrate levels in advanced heart failure with reduced ejection fraction: determinants and prognostic impact

Original language description

AimsPatients with heart failure (HF) display metabolic alterations, including heightened ketogenesis, resulting in increased beta-hydroxybutyrate (beta-OHB) formation. We aimed to investigate the determinants and prognostic impact of circulating beta-OHB levels in patients with advanced HF and reduced ejection fraction (HFrEF).Methods and resultsA total of 867 patients with advanced HFrEF (age 57 +/- 11 years, 83% male, 45% diabetic, 60% New York Heart Association class III), underwent clinical and echocardiographic examination, circulating metabolite assessment, and right heart catheterization (n = 383). The median beta-OHB level was 64 (interquartile range [IQR] 33-161) mu mol/L (normal 0-74 mu mol/L). beta-OHB levels correlated with increased markers of lipolysis (free fatty acids [FFA]), higher natriuretic peptides, worse pulmonary haemodynamics, and lower humoral regulators of ketogenesis (insulin/glucagon ratio). During a median follow-up of 1126 (IQR 410-1781) days, there were 512 composite events, including 324 deaths, 81 left ventricular assist device implantations and 107 urgent cardiac transplantations. In univariable Cox regression, increased beta-OHB levels (T3 vs. T1: hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.13-1.72, p = 0.002) and elevated FFA levels (T3 vs. T1: HR 1.39, 95% CI 1.09-1.79, p = 0.008) were both predictors of a worse prognosis. In multivariable Cox analysis evaluating the simultaneous associations of FFA and beta-OHB levels with outcomes, only FFA levels remained significantly associated with adverse outcomes.ConclusionsIn patients with advanced HFrEF, increased plasma beta-OHB correlate with FFA levels, worse right ventricular function, greater neurohormonal activation and other markers of HF severity. The association between plasma beta-OHB and adverse outcomes is eliminated after accounting for FFA levels, suggesting that increased beta-OHB is a consequence reflecting heightened lipolytic state, rather than a cause of worsening HF. Summary of the study design and key findings. In the central panel, (+) and (-) means that the variable is directly or inversely associated with beta-hydroxybutyrate (beta-OHB) levels, respectively. The gold arrow means that free fatty acid (FFA) levels are the only variable that remained associated with beta-OHB levels in the multivariable model. HFrEF, heart failure with reduced ejection fraction; HOMA-IR, homeostasis model assessment of insulin resistance; LV, left ventricular; RHC, right heart catheterization; RV, right ventricular; TG, triglycerides. Parts of the figure were created using Biorender.com. image

Czech name

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Czech description

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Type

J_imp - Article in a specialist periodical, which is included in the Web of Science database

CEP classification

—

OECD FORD branch

30201 - Cardiac and Cardiovascular systems

Project

Result was created during the realization of more than one project. More information in the Projects tab.

Continuities

P - Projekt vyzkumu a vyvoje financovany z verejnych zdroju (s odkazem do CEP)<br>I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Publication year

2024

Confidentiality

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů

Name of the periodical

European journal of heart failure

ISSN

1388-9842

e-ISSN

1879-0844

Volume of the periodical

26

Issue of the periodical within the volume

9

Country of publishing house

GB - UNITED KINGDOM

Number of pages

10

Pages from-to

1931-1940

UT code for WoS article

001241397100001

EID of the result in the Scopus database

2-s2.0-85195578021