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Neves LS, Saraiva F, Ferreira R, Leite-Moreira A, Barros AS, Diaz SO. Metabolomics and Cardiovascular Risk in Patients with Heart Failure: A Systematic Review and Meta-Analysis. Int J Mol Sci 2024; 25:5693. [PMID: 38891881 PMCID: PMC11172189 DOI: 10.3390/ijms25115693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 05/17/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
The associations of plasma metabolites with adverse cardiovascular (CV) outcomes are still underexplored and may be useful in CV risk stratification. We performed a systematic review and meta-analysis to establish correlations between blood metabolites and adverse CV outcomes in patients with heart failure (HF). Four cohorts were included, involving 83 metabolites and 37 metabolite ratios, measured in 1158 HF patients. Hazard ratios (HR) of 42 metabolites and 3 metabolite ratios, present in at least two studies, were combined through meta-analysis. Higher levels of histidine (HR 0.74, 95% CI [0.64; 0.86]) and tryptophan (HR 0.82 [0.71; 0.96]) seemed protective, whereas higher levels of symmetric dimethylarginine (SDMA) (HR 1.58 [1.30; 1.93]), N-methyl-1-histidine (HR 1.56 [1.27; 1.90]), SDMA/arginine (HR 1.38 [1.14; 1.68]), putrescine (HR 1.31 [1.06; 1.61]), methionine sulfoxide (HR 1.26 [1.03; 1.52]), and 5-hydroxylysine (HR 1.25 [1.05; 1.48]) were associated with a higher risk of CV events. Our findings corroborate important associations between metabolic imbalances and a higher risk of CV events in HF patients. However, the lack of standardization and data reporting hampered the comparison of a higher number of studies. In a future clinical scenario, metabolomics will greatly benefit from harmonizing sample handling, data analysis, reporting, and sharing.
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Affiliation(s)
- Leonel Sousa Neves
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (L.S.N.); (F.S.); (A.L.-M.)
| | - Francisca Saraiva
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (L.S.N.); (F.S.); (A.L.-M.)
| | - Rita Ferreira
- LAQV-REQUIMTE, Department of Chemistry, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Adelino Leite-Moreira
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (L.S.N.); (F.S.); (A.L.-M.)
| | - António S. Barros
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (L.S.N.); (F.S.); (A.L.-M.)
| | - Sílvia O. Diaz
- Cardiovascular R&D Centre, UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (L.S.N.); (F.S.); (A.L.-M.)
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2
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McGranaghan P, Kirwan JA, Garcia-Rivera MA, Pieske B, Edelmann F, Blaschke F, Appunni S, Saxena A, Rubens M, Veledar E, Trippel TD. Lipid Metabolite Biomarkers in Cardiovascular Disease: Discovery and Biomechanism Translation from Human Studies. Metabolites 2021; 11:621. [PMID: 34564437 PMCID: PMC8470800 DOI: 10.3390/metabo11090621] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 08/30/2021] [Accepted: 09/06/2021] [Indexed: 12/12/2022] Open
Abstract
Lipids represent a valuable target for metabolomic studies since altered lipid metabolism is known to drive the pathological changes in cardiovascular disease (CVD). Metabolomic technologies give us the ability to measure thousands of metabolites providing us with a metabolic fingerprint of individual patients. Metabolomic studies in humans have supported previous findings into the pathomechanisms of CVD, namely atherosclerosis, apoptosis, inflammation, oxidative stress, and insulin resistance. The most widely studied classes of lipid metabolite biomarkers in CVD are phospholipids, sphingolipids/ceramides, glycolipids, cholesterol esters, fatty acids, and acylcarnitines. Technological advancements have enabled novel strategies to discover individual biomarkers or panels that may aid in the diagnosis and prognosis of CVD, with sphingolipids/ceramides as the most promising class of biomarkers thus far. In this review, application of metabolomic profiling for biomarker discovery to aid in the diagnosis and prognosis of CVD as well as metabolic abnormalities in CVD will be discussed with particular emphasis on lipid metabolites.
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Affiliation(s)
- Peter McGranaghan
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, 13353 Berlin, Germany; (P.M.); (B.P.); (F.E.); (F.B.)
- Baptist Health South Florida, Miami, FL 33143, USA; (A.S.); (M.R.); (E.V.)
| | - Jennifer A. Kirwan
- Metabolomics Platform, Berlin Institute of Health at Charité Universitätsmedizin Berlin, 13353 Berlin, Germany; (J.A.K.); (M.A.G.-R.)
- Max Delbrück Center for Molecular Research, 13125 Berlin, Germany
- School of Veterinary Medicine and Science, University of Nottingham, Leicestershire LE12 5RD, UK
| | - Mariel A. Garcia-Rivera
- Metabolomics Platform, Berlin Institute of Health at Charité Universitätsmedizin Berlin, 13353 Berlin, Germany; (J.A.K.); (M.A.G.-R.)
- Max Delbrück Center for Molecular Research, 13125 Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, 13353 Berlin, Germany; (P.M.); (B.P.); (F.E.); (F.B.)
- DZHK (German Centre for Cardiovascular Research), 13353 Berlin, Germany
- Berlin Institute of Health, 13353 Berlin, Germany
- German Heart Center Berlin, Department of Cardiology, 13353 Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, 13353 Berlin, Germany; (P.M.); (B.P.); (F.E.); (F.B.)
- DZHK (German Centre for Cardiovascular Research), 13353 Berlin, Germany
- German Heart Center Berlin, Department of Cardiology, 13353 Berlin, Germany
| | - Florian Blaschke
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, 13353 Berlin, Germany; (P.M.); (B.P.); (F.E.); (F.B.)
- DZHK (German Centre for Cardiovascular Research), 13353 Berlin, Germany
| | - Sandeep Appunni
- Department of Biochemistry, Government Medical College, Kozhikode, Kerala 673008, India;
| | - Anshul Saxena
- Baptist Health South Florida, Miami, FL 33143, USA; (A.S.); (M.R.); (E.V.)
| | - Muni Rubens
- Baptist Health South Florida, Miami, FL 33143, USA; (A.S.); (M.R.); (E.V.)
| | - Emir Veledar
- Baptist Health South Florida, Miami, FL 33143, USA; (A.S.); (M.R.); (E.V.)
- Department of Biostatistics, Florida International University, Miami, FL 33199, USA
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Tobias Daniel Trippel
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, 13353 Berlin, Germany; (P.M.); (B.P.); (F.E.); (F.B.)
- DZHK (German Centre for Cardiovascular Research), 13353 Berlin, Germany
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3
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Bueno H, Moura B, Lancellotti P, Bauersachs J. The year in cardiovascular medicine 2020: heart failure and cardiomyopathies. Eur Heart J 2021; 42:657-670. [PMID: 33388764 DOI: 10.1093/eurheartj/ehaa1061] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/26/2020] [Accepted: 12/22/2020] [Indexed: 12/22/2022] Open
Affiliation(s)
- Héctor Bueno
- Multidisciplinary Translational Cardiovascular Research Group. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández Almagro, 3, Madrid 28029, Spain.,Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital, 12 de Octubre (imas12), Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Plaza de Ramón y Cajal, s/n, 28040 Madrid, Spain
| | - Brenda Moura
- Cardiology Department, Military Hospital, Av. da Boavista S/N, 4050-115 Porto, Portugal.,CINTESIS-Center for Health Technology and Services Research, R. Dr. Plácido da Costa, 4200-450 Porto, Portugal
| | - Patrizio Lancellotti
- Department of Cardiology, CHU SartTilman, University of Liège Hospital, GIGA Cardiovascular Sciences, Avenue de L'Hôpital 1, 4000 Liège, Belgium.,Cardiology Departments, Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola Bari, Italy and Via Corriera, 1, 48033 Cotignola RA, Italy and Anthea Hospital, Via Camillo Rosalba, 35/37, 70124 Bari BA, Italy
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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McGranaghan P, Saxena A, Düngen HD, Rubens M, Appunni S, Salami J, Veledar E, Lacour P, Blaschke F, Obradovic D, Loncar G, Tahirovic E, Edelmann F, Pieske B, Trippel TD. Performance of a cardiac lipid panel compared to four prognostic scores in chronic heart failure. Sci Rep 2021; 11:8164. [PMID: 33854188 PMCID: PMC8046832 DOI: 10.1038/s41598-021-87776-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/05/2021] [Indexed: 02/02/2023] Open
Abstract
The cardiac lipid panel (CLP) is a novel panel of metabolomic biomarkers that has previously shown to improve the diagnostic and prognostic value for CHF patients. Several prognostic scores have been developed for cardiovascular disease risk, but their use is limited to specific populations and precision is still inadequate. We compared a risk score using the CLP plus NT-proBNP to four commonly used risk scores: The Seattle Heart Failure Model (SHFM), Framingham risk score (FRS), Barcelona bio-HF (BCN Bio-HF) and Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score. We included 280 elderly CHF patients from the Cardiac Insufficiency Bisoprolol Study in Elderly trial. Cox Regression and hierarchical cluster analysis was performed. Integrated area under the curves (IAUC) was used as criterium for comparison. The mean (SD) follow-up period was 81 (33) months, and 95 (34%) subjects met the primary endpoint. The IAUC for FRS was 0.53, SHFM 0.61, BCN Bio-HF 0.72, MAGGIC 0.68, and CLP 0.78. Subjects were partitioned into three risk clusters: low, moderate, high with the CLP score showing the best ability to group patients into their respective risk cluster. A risk score composed of a novel panel of metabolite biomarkers plus NT-proBNP outperformed other common prognostic scores in predicting 10-year cardiovascular death in elderly ambulatory CHF patients. This approach could improve the clinical risk assessment of CHF patients.
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Affiliation(s)
- Peter McGranaghan
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.418212.c0000 0004 0465 0852Baptist Health South Florida, 6855 Red Rd, Coral Gables, FL 33143 USA
| | - Anshul Saxena
- grid.418212.c0000 0004 0465 0852Baptist Health South Florida, 6855 Red Rd, Coral Gables, FL 33143 USA
| | - Hans-Dirk Düngen
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Muni Rubens
- grid.418212.c0000 0004 0465 0852Baptist Health South Florida, 6855 Red Rd, Coral Gables, FL 33143 USA
| | - Sandeep Appunni
- grid.253527.40000 0001 0705 6304Department of Biochemistry, Government Medical College, Kozhikode, Kerala 673008 India
| | - Joseph Salami
- grid.418212.c0000 0004 0465 0852Baptist Health South Florida, 6855 Red Rd, Coral Gables, FL 33143 USA
| | - Emir Veledar
- grid.418212.c0000 0004 0465 0852Baptist Health South Florida, 6855 Red Rd, Coral Gables, FL 33143 USA ,grid.65456.340000 0001 2110 1845Department of Biostatistics, Florida International University, Miami, FL USA ,grid.189967.80000 0001 0941 6502Division of Cardiology, Emory University School of Medicine, Atlanta, GA USA
| | - Philipp Lacour
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Florian Blaschke
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Danilo Obradovic
- grid.9647.c0000 0004 7669 9786Department of Cardiology and Internal Medicine, Heart Center Leipzig at the University of Leipzig, Russenstrasse 69A, 04289 Leipzig, Germany
| | - Goran Loncar
- grid.7149.b0000 0001 2166 9385Institute for Cardiovascular Diseases Dedinje, Department of Cardioloy, Faculty of Medicine, University of Belgrade, Heroja Milana Tepića br. 1, 11040 Belgrade, Serbia
| | - Elvis Tahirovic
- grid.11374.300000 0001 0942 1176Apostolovic Clinic for Cardiovascular Diseases, Clinical Centre Nis, University of Niš, Niš, Serbia
| | - Frank Edelmann
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Centre for Cardiovascular Research), Berlin, Germany ,grid.484013.aBerlin Institute of Health (BIH), Berlin, Germany
| | - Burkert Pieske
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Centre for Cardiovascular Research), Berlin, Germany ,grid.484013.aBerlin Institute of Health (BIH), Berlin, Germany ,Department of Internal Medicine and Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Tobias Daniel Trippel
- grid.6363.00000 0001 2218 4662Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany ,grid.452396.f0000 0004 5937 5237DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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5
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Lainscak M, Dora E, Doehner W, Obradovic D, Loncar G. Beware of TOSCA's kiss or metabolic and hormonal aspects of heart failure. Eur J Prev Cardiol 2021; 28:1701-1703. [PMID: 33778865 DOI: 10.1093/eurjpc/zwab051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mitja Lainscak
- Division of Cardiology, General Hospital Murska Sobota, Dr. Vrbnjaka 6, Murska Sobota SI-9000, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana SI-1000, Slovenia.,Faculty of Natural Sciences and Mathematics, University of Maribor, Maribor, Slovenia
| | - Eva Dora
- Division of Cardiology, General Hospital Murska Sobota, Dr. Vrbnjaka 6, Murska Sobota SI-9000, Slovenia
| | - Wolfram Doehner
- Berlin Institute of Health Center for Regenerative Therapies, Charite, Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiology (Virchow Klinikum), Charité - Universitätsmedizin Berlin, German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Danilo Obradovic
- Department of Cardiology/Internal Medicine, Heart Center Leipzig-University Leipzig, Leipzig, Germany
| | - Goran Loncar
- Dedinje Cardiovascular Institute, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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6
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McGranaghan P, Düngen HD, Saxena A, Rubens M, Salami J, Radenkovic J, Bach D, Apostolovic S, Loncar G, Zdravkovic M, Tahirovic E, Veskovic J, Störk S, Veledar E, Pieske B, Edelmann F, Trippel TD. Incremental prognostic value of a novel metabolite-based biomarker score in congestive heart failure patients. ESC Heart Fail 2020; 7:3029-3039. [PMID: 32860352 PMCID: PMC7524071 DOI: 10.1002/ehf2.12928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 06/07/2020] [Accepted: 07/19/2020] [Indexed: 01/29/2023] Open
Abstract
Aims The Cardiac Lipid Panel (CLP) is a newly discovered panel of metabolite‐based biomarkers that has shown to improve the diagnostic value of N terminal pro B type natriuretic peptide (NT‐proBNP). However, little is known about its usefulness in predicting outcomes. In this study, we developed a risk score for 4‐year cardiovascular death in elderly chronic heart failure (CHF) patients using the CLP. Methods and results From the Cardiac Insufficiency Bisoprolol Study in Elderly trial, we included 280 patients with CHF aged >65 years. A targeted metabolomic analysis of the CLP biomarkers was performed on baseline serum samples. Cox regression was used to determine the association of the biomarkers with the outcome after accounting for established risk factors. A risk score ranging from 0 to 4 was calculated by counting the number of biomarkers above the cut‐offs, using Youden index. During the mean (standard deviation) follow‐up period of 50 (8) months, 35 (18%) subjects met the primary endpoint of cardiovascular death. The area under the receiver operating curve for the model based on clinical variables was 0.84, the second model with NT‐proBNP was 0.86, and the final model with the CLP was 0.90. The categorical net reclassification index was 0.25 using three risk categories: 0–60% (low), 60–85% (intermediate), and >85% (high). The continuous net reclassification index was 0.772, and the integrated discrimination index was 0.104. Conclusions In patients with CHF, incorporating a panel of three metabolite‐based biomarkers into a risk score improved the prognostic utility of NT‐proBNP by predicting long‐term cardiovascular death more precisely. This novel approach holds promise to improve clinical risk assessment in CHF patients.
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Affiliation(s)
- Peter McGranaghan
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,Baptist Health South Florida, Coral Gables, FL, USA
| | - Hans-Dirk Düngen
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | | | - Muni Rubens
- Baptist Health South Florida, Coral Gables, FL, USA
| | | | - Jasmin Radenkovic
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Doris Bach
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Svetlana Apostolovic
- Clinic for Cardiovascular Diseases, Clinical Centre Niš, University of Niš, Niš, Serbia
| | - Goran Loncar
- Department of Cardiology, Institute for Cardiovascular Diseases Dedinje, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marija Zdravkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology, University Hospital Medical Center Bezanijska Kosa, Belgrade, Serbia
| | - Elvis Tahirovic
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Jovan Veskovic
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center Würzburg, University and University Hospital Würzburg, Würzburg, Germany
| | - Emir Veledar
- Baptist Health South Florida, Coral Gables, FL, USA
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Tobias Daniel Trippel
- Department of Internal Medicine and Cardiology, Charité Campus Virchow-Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
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