1H nuclear magnetic resonance based metabolic urinary profiling of patients with ischemic heart failure

Objectives: We sought to identify metabolic pathways characterizing human heart failure (HF) using ¹NMR based urinary metabolomic analysis in conjunction with multivariate statistics. Design and methods: Patients with systolic HF of ischemic origin (n = 15) and healthy controls (n. = 20) participated in this study. Patients with type 2 diabetes mellitus were excluded. Results: The results showed that the urine of the HF patients had higher levels of metabolites for acetate (p < 0.05) and acetone (p < 0.01) compared to the healthy controls. In addition, there was a perturbation in methylmalonate metabolism as shown by increased urinary levels of methylmalonic acid (p < 0.001) in the HF patients. HF patients also had increased urinary levels of cytosine (p < 0.01) and phenylacetylglycine (p < 0.01) and decreased 1-methylnicotinamide (p < 0.05) compared to healthy controls. Conclusions: TCA cycle metabolites and fatty acid metabolism were modified in the HF patients, indicating altered energy metabolism. Moreover, perturbations of metabolism in nucleotide and methylmalonate were observed.