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Chest

Title:		Breath analysis in pulmonary arterial hypertension
Author(s):		Cikach FS; Tonelli AR; Barnes J; Paschke K; Newman J; Grove D; Dababneh L; Wang S; Dweik RA;
Address:		"Pathobiology Department, Lerner Research Institute, Cleveland Clinic, Cleveland, OH. Department of Pulmonary, Allergy and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH. Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH. Pathobiology Department, Lerner Research Institute, Cleveland Clinic, Cleveland, OH. Electronic address: dweikr@ccf.org"
Journal Title:		Chest
Year:		2014
Volume:		145
Issue:		3
Page Number:		551 - 558
DOI:		10.1378/chest.13-1363
ISSN/ISBN:		1931-3543 (Electronic) 0012-3692 (Print) 0012-3692 (Linking)
Abstract:		"BACKGROUND: Pulmonary arterial hypertension (PAH) is a progressive and devastating condition characterized by vascular cell proliferation and is associated with several metabolic derangements. We hypothesized that metabolic derangements in PAH can be detected by measuring metabolic by-products in exhaled breath. METHODS: We collected breath and blood samples from patients with PAH at the time of right-sided heart catheterization (n=31) and from healthy control subjects (n=34). Breath was analyzed by selected ion flow tube-mass spectrometry in predetermined training and validation cohorts. RESULTS: Patients with PAH were 51.5+/-14 years old, and 27 were women (85%). Control subjects were 38+/-13 years old, and 22 were women (65%). Discriminant analysis in the training set identified three ion peaks (H3O+29+, NO+56+, and O2+98+) and the variable age that correctly classified 88.9% of the individuals. In an independent validation cohort, 82.8% of the individuals were classified correctly. The concentrations of the volatile organic compounds 2-propanol, acetaldehyde, ammonia, ethanol, pentane, 1-decene, 1-octene, and 2-nonene were different in patients with PAH compared with control subjects. Exhaled ammonia was higher in patients with PAH (median [interquartile range]: 94.7 parts per billion (ppb) [70-129 ppb] vs 60.9 ppb [46-77 ppb], P<.001) and was associated with right atrial pressure (rho=0.57, P<.001), mean pulmonary artery pressure (rho=0.43, P=.015), cardiac index by thermodilution (rho=-0.39, P=.03), pulmonary vascular resistance (rho=0.40, P=.04), mixed venous oxygen (rho=-0.59, P<.001), and right ventricular dilation (rho=0.42, P=.03). CONCLUSIONS: Breathprint is different between patients with PAH and healthy control subjects. Several specific compounds, including ammonia, were elevated in the breath of patients with PAH. Exhaled ammonia levels correlated with severity of disease"
Keywords:		"Adult Air/*analysis Breath Tests/methods Cardiac Catheterization Exhalation Familial Primary Pulmonary Hypertension Female Humans Hypertension, Pulmonary/*metabolism/physiopathology Male Mass Spectrometry Middle Aged Prognosis Severity of Illness Index Va;"
Notes:		"MedlineCikach, Frank S Jr Tonelli, Adriano R Barnes, Jarrod Paschke, Kelly Newman, Jennie Grove, David Dababneh, Luma Wang, Sihe Dweik, Raed A eng P01 HL107147/HL/NHLBI NIH HHS/ P01 HL081064/HL/NHLBI NIH HHS/ HL081064/HL/NHLBI NIH HHS/ HL107147/HL/NHLBI NIH HHS/ KL2 RR024990/RR/NCRR NIH HHS/ F32 HL120629/HL/NHLBI NIH HHS/ R21 RR026231/RR/NCRR NIH HHS/ KL2 TR000440/TR/NCATS NIH HHS/ RR026231/RR/NCRR NIH HHS/ Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov't 2013/10/05 Chest. 2014 Mar 1; 145(3):551-558. doi: 10.1378/chest.13-1363"