Characterization of inflammatory profile by breath analysis in chronic coronary syndromes

Updates in breathomics behavior in ischemic heart disease and heart failure, mass-spectrometry

BACKGROUND

Cardiovascular disease (CVD) and associated sequalae remain the leading cause of disability worldwide. Ischemic heart disease (IHD) and heart failure are the most common etiologies of morbidity and mortality worldwide. This is due to the poor diagnostic and management methods for heart failure and IHD. Early detection of related risk factors through modern strategies is underestimated and requires further research.

AIM

To interpret data from the published literature on volatile organic compounds (VOC), including all the methods used to analyze exhaled breath in patients with IHD and heart failure.

METHODS

Searches for specific keywords were performed on Scopus and PubMed. A total of 20 studies were identified in breath analysis and IHD and heart failure. The study is registered in PROSPERO (Registration No. CRD42023470556).

RESULTS

Considering the articles found, more research is required to gain a full understanding of the role of VOCs in IHD and heart failure. However, the existing literature demonstrates that cardiac metabolic changes can be expressed in exhaled air. The number of papers found is extremely low, making interpretation extremely difficult.

CONCLUSION

Exhaled breath analysis can be a novel biomarker for the diagnosis and prevention of heart failure and IHD. Exhaled breath analysis can be used as a mirror to reflect the metabolic changes related to IHD and heart failure.

Breath Analysis via Gas Chromatography-Mass Spectrometry (GC-MS) in Chronic Coronary Syndrome (CCS): A Proof-of-Concept Study

Background: This proof-of-concept study aimed to assess the diagnostic potential of gas chromatography-mass spectrometry (GC-MS) in profiling volatile organic compounds (VOCs) from exhaled breath as a diagnostic tool for the chronic coronary syndrome (CCS). Methods: Exhaled air was collected from patients undergoing invasive coronary angiography (ICA), with all samples obtained prior to ICA. Post hoc, patients were divided into groups based on coronary lesion severity and indications for revascularization. VOCs in the breath samples were analyzed using GC-MS. Results: This study included 23 patients, of whom 11 did not require myocardial revascularization and 12 did. GC-MS analysis successfully classified 10 of the 11 patients without the need for revascularization (sensitivity of 91%), and 7 of the 12 patients required revascularization (specificity 58%). In subgroup analysis, GC-MS demonstrated 100% sensitivity in identifying patients with significant coronary lesions requiring intervention when the cohort was divided into three groups. A total of 36 VOCs, including acetone, ethanol, and phenol, were identified as distinguishing markers between patient groups. Conclusions: Patients with CCS exhibited a unique fingerprint of exhaled breath, which was detectable with GC-MS. These findings suggest that GC-MS analysis could be a reliable and non-invasive diagnostic tool for CCS. Further studies with larger cohorts are necessary to validate these results and explore the potential integration of VOC analysis into clinical practice.

Listing Criteria for Heart Transplant: Role of Cardiopulmonary Exercise Test and of Prognostic Scores

Patients with advanced heart failure (AdHF) have a reduced quality of life and poor prognosis. A heart transplant (HT) is an effective treatment for such patients. Still, because of a shortage of donor organs, the final decision to place a patient without contraindications on the HT waiting list is based on detailed risk-benefit analysis. Cardiopulmonary exercise tests (CPETs) play a pivotal role in guiding selection in patients with AdHF considered for an HT. Furthermore, several validated multivariable predicting scores obtained through various techniques, including the CPETs, are available and part of the decision-making process for HT listing.