Breath acetone changes in decompensated heart failure patients on inotropes

Early assessment of treatment response in patients with decompensated heart failure (HF) requiring inotropic support remains challenging. Exhaled breath acetone, a noninvasive marker of ketone body metabolism, may reflect dynamic metabolic changes associated with clinical status. We aimed to evaluate short-term temporal changes in exhaled breath acetone levels following inotropic therapy in patients with decompensated HF. This is a prospective, single-center observational study including patients with HF requiring inotropic therapy. Exhaled breath acetone levels were measured in decompensated HF patients requiring inotropic support using a previously described noninvasive device at hospital admission and within 48 h. The analysis was performed by spectrophotometry after reaction with salicylaldehyde. Ninety-seven patients were enrolled. Baseline median exhaled breath acetone concentration at admission was 7.75 (3.90-12.27)µg l^-1and decreased to 2.15 (1.10-4.19)µg l^-1after 48 h of inotrope initiation (p< 0.001 for within-patient comparison). This reduction was accompanied by clinical improvement in signs of HF decompensation and occurred in patients with or without type 2 diabetes, although the magnitude of this reduction was greater in patients without diabetes (p= 0.001). Elevated exhaled breath acetone levels were observed in patients with decompensated HF and decreased after initiation of inotropic therapy, paralleling clinical improvement. These findings are hypothesis-generating and larger prospective studies may confirm the potential role of exhaled breath acetone in clinical decision-making.