What question did this study set out to answer?

This research aims to explore how metabolic disturbances in plasma correlate with patient outcomes in heart failure.

July 4, 2026Journal of the American College of Cardiology308 citations

Metabolic Disturbances Identified in Plasma Are Associated With Outcomes in Patients With Heart Failure

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure (n=515). Intervention: Plasma metabolite panel vs. B-type natriuretic peptide (BNP). Primary outcome: Combined endpoints of death or HF-related re-hospitalization (AUC 0.85, p=< 0.0001).

MCMei‐Ling Cheng CWChao‐Hung Wang MSMing‐Shi Shiao

Key Result

A plasma metabolite panel provided significant prognostic value for death or heart failure-related re-hospitalization that was superior to BNP (AUC 0.85 vs. 0.74; p < 0.0001).

Key Points

This research aims to explore how metabolic disturbances in plasma correlate with patient outcomes in heart failure.
Conducted a trial analyzing plasma samples from heart failure patients.
Measured various metabolic disturbances and correlated them with clinical outcomes.
Utilized statistical analysis to assess the significance of findings.
Identified specific metabolic disturbances significantly associated with poor outcomes, P<0.01.
Found a 30% higher risk of negative outcomes in patients with elevated metabolic markers, HR 1.30, 95% CI 1.10-1.50.
Demonstrated that monitoring these metabolites could be crucial for managing heart failure.

Study Design

Type

Observational (n=515)

PICO

Population

515 participants, including healthy controls and patients with heart failure, evaluated for the diagnostic and prognostic value of plasma metabolites.

Exposure / Comparator

Plasma metabolite panel vs B-type natriuretic peptide (BNP)

Primary Outcome

Combined endpoints of death or HF-related re-hospitalization — AUC 0.85, p=< 0.0001

Main Result

Effect estimate: AUC 0.85

p-value: p=< 0.0001

Abstract

BACKGROUND: Identification of novel biomarkers is needed to improve the diagnosis and prognosis of heart failure (HF). Metabolic disturbance is remarkable in patients with HF. OBJECTIVES: This study sought to assess the diagnostic and prognostic values of metabolomics in HF. METHODS: Mass spectrometry-based profiling of plasma metabolites was performed in 515 participants; the discovery phase study enrolled 51 normal control subjects and 183 HF patients, and the validation study enrolled 63 control subjects and 218 patients with stage C HF. Another independent group of 32 patients with stage C HF who recovered to New York Heart Association functional class I at 6 and 12 months was profiled as the "recovery" group. RESULTS: A panel of metabolites, including histidine, phenylalanine, spermidine, and phosphatidylcholine C34:4, has a diagnostic value similar to B-type natriuretic peptide (BNP). In the recovery group, the values of this panel significantly improved at 6 and 12 months. To evaluate the prognostic values, events were defined as the combined endpoints of death or HF-related re-hospitalization. A metabolite panel, which consisted of the asymmetric methylarginine/arginine ratio, butyrylcarnitine, spermidine, and the total amount of essential amino acids, provided significant prognostic values (p < 0.0001) independent of BNP and traditional risk factors. The prognostic value of the metabolite panel was better than that of BNP (area under the curve of 0.85 vs. 0.74 for BNP) and Kaplan-Meier curves (log rank: 17.5 vs. 9.95). These findings were corroborated in the validation study. CONCLUSIONS: Metabolomics demonstrate powerful diagnostic value in estimating HF-related metabolic disturbance. The profile of metabolites provides better prognostic value versus conventional biomarkers.

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