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- The phenotype of that: scientists will increase the accuracy of diagnosis of heart failure
The phenotype of that: scientists will increase the accuracy of diagnosis of heart failure
Russian specialists were the first in the world to identify four new metabolic phenotypes, that is, unique "imprints" of chemical processes in the body of patients with chronic heart failure. Each has its own characteristics. The data obtained will help to improve the diagnosis of the disease and predict its course. In the future, depending on the patient's phenotype, doctors will be able to prescribe more accurate personalized treatment. The doctors interviewed by Izvestia highly appreciated the method, but noted that so far it is rather of scientific interest and is still far from being implemented in clinical practice.
What is chronic heart failure?
Doctors of the Department of Hospital Therapy No. 1 at Sechenov University, together with scientists from the Center for Biopharmaceutical Technologies and Metabolic Analysis at the First Moscow State Medical University, have developed a new method for diagnosing chronic heart failure (CHF) by analyzing the metabolic profile. This is a comprehensive analysis that provides information about the metabolic state of the body. We are talking about unique chemical "fingerprints" specific to the processes occurring in living cells.
Chronic heart failure (CHF) is one of the most severe and poorly predicted pathologies. The survival rate of patients is low and does not exceed 50% for five years.
Currently, to detect chronic heart failure, doctors evaluate the level of natriuretic peptides (heart hormones) in a biochemical analysis of the patient's blood. However, they are not always specific for the diagnosis of this severe pathology, said the author of the scientific work, professor of the department, MD Maria Kozhevnikova. For example, the brain natriuretic peptide can increase not only in CHF, but also in anemia, chronic kidney disease, and cancer. Therefore, in order to make an accurate diagnosis, a complex of instrumental and laboratory examination methods is needed.
"In search of more reliable diagnostic solutions, we tried to use an alternative method for detecting heart failure — metabolic profiling, that is, the analysis of metabolites — products of metabolism occurring in the body," she explained to Izvestia. — Our study has confirmed that using metabolic profiling, it is indeed possible to determine whether a patient has CHF or not. Moreover, this method has a high sensitivity and specificity.
In addition, the scientists evaluated different variants of heart failure — with a preserved left ventricular ejection fraction and a low ejection fraction. There are different approaches to treatment for them, the doctors said. Therefore, it was important to determine the metabolomic profile for each individual variant.
"If any abnormalities in the metabolic pathways are identified, this opens up the potential for developing therapies specifically aimed at eliminating these abnormalities,— said Maria Kozhevnikova.
A new method for diagnosing heart failure
A total of 498 people participated in the study. Of these, 415 patients with various cardiovascular diseases, including chronic heart failure (218 people), and 83 healthy volunteers. The participants underwent a quantitative blood metabolome analysis using high-performance liquid chromatography combined with mass spectrometry.
The profile of patients with cardiovascular diseases was compared with the reference values of healthy participants. Then, using machine learning algorithms, the scientists identified four metabolic phenotypes of chronic heart failure and identified the characteristics of each of them, from signs of inflammation to mitochondrial dysfunction and nitric oxide (NO) deficiency.
— This is a completely new approach, before us in the world no one had classified patients with heart failure according to their metabolic profile, — said Maria Kozhevnikova. — Determining the patient's metabolic profile and phenotype can help improve the treatment of chronic heart failure. Some have signs of inflammation, while others have signs of free radical release. Therapy in this case may vary.
Scientists suggest that if, in addition to standard treatment, patients are prescribed personalized therapy aimed at eliminating inflammation or other identified pathophysiological features, the risks of an adverse outcome of this pathology can be reduced.
In addition to identifying four phenotypes of heart failure, during the study, scientists developed a metabolomic panel that significantly simplifies and accelerates the diagnosis of the disease with a preserved ejection fraction (SNFV). After analyzing blood plasma samples from patients with hypertension and a confirmed diagnosis of NSFV, they identified a unique combination of metabolites and their ratios that make it possible to clearly distinguish patients with NSFV from those with only risk factors. The proposed metabolomic panel showed high accuracy and surpassed traditional markers: the sensitivity of the model was 94.4%, and the specificity was 100%.
Applying the new method in practice
The topic of heart failure is relevant because it is a serious disease that increases people's mortality. Statistics show that this disease is one of the most common causes of hospitalization and death both in Russia and abroad. Therefore, any research related to CHF is interesting, Galina Lifshits, MD, market expert at NTI Healthnet, told Izvestia.
— Scientists have applied new modern techniques that are now quite often used in scientific research in biology and medicine: liquid mass spectrometry and metabolomic analysis. Although the study is interesting and, of course, important, today it is unlikely to have much practical relevance and prospects for quickly switching to routine use," she noted.
According to her, scientists offer complex biochemical analysis, which requires special resources, which today are mainly possessed by scientific research organizations. Nevertheless, with further work, the study can bring many benefits to patients.
The diagnosis of heart failure at an early stage, the opportunity to start timely treatment and prevent the development of a severe symptomatic disease are important for patients and doctors, says Elena Golikova, a cardiologist and a leading specialist in the Semeynaya clinic network. Hippocrates' words "it is easier to prevent a disease than to treat it" will never lose their relevance, she noted.
— However, at the moment this method has not gone beyond the scope of the experiment: the results of a study of 498 people (218 of them had heart failure) are presented. There is no data on how effective treatment will be in accordance with the identified metabolic profiles and how this approach will affect the prognosis of patients. There are also open questions about what the cost of the metabolome panel will be in real clinical practice and how accessible it will become for widespread use as screening," the expert added.
Thus, to assess the importance, usefulness and applicability of the proposed method, studies on the treatment of patients with CHF and the first results of implementation in real practice should be expected, the specialist concluded.
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