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Inverse shift in serum polyunsaturated and monounsaturated fatty acids is associated with adverse dilatation of the heart
  1. Heinz Rupp (rupp{at}
  1. Department Internal Medicine, Cardiology, Germany
    1. Thomas Philipp Rupp (cardio-ex{at}
    1. Department Internal Medicine, Cardiology, Germany
      1. Peter Alter (cardio-ex{at}
      1. Department Internal Medicine, Cardiology, Germany
        1. Bernhard Maisch (cardio-ex{at}
        1. Department Internal Medicine, Cardiology, Germany


          Background: Cardiac dilatation is associated with impaired pump function, progression of heart failure and electrical instability. Risk of sudden death is associated with a low blood level of n-3 polyunsaturated fatty acids.

          Objective: The hypothesis was, therefore, addressed that left ventricular dilatation as assessed by echocardiography is associated with a reduced serum polyunsaturated fatty acid level.

          Methods: Fatty acids were determined with gas chromatography/mass spectrometry in serum of 308 patients with dilative heart failure unrelated to myocardial infarction (Age 48±12 years, NYHA class 2.2±0.6, ejection fraction 31±10%).

          Results: The extent of left ventricular dilatation as assessed by left ventricular enddiastolic diameter was associated with a reduction of both n-3 and n-6 polyunsaturated fatty acids. The n-3 docosahexaenoic acid (1.0±0.5% vs. 1.3±0.6%, P<0.001) and the n-6 arachidonic acid (4.6±1.8% vs. 5.2±1.9%, P<0.01) were reduced in patients with left ventricular dilatation (enddiastolic diameter, 68-90 mm, upper tertile vs. 48-61 mm, lower tertile). By contrast, monounsaturated fatty acids were increased (the n-9 oleic acid 26.1±4.8% vs. 23.9±4.8%, P<0.01). A low docosahexaenoic acid (0.01-0.9%, lower tertile vs. 1.4-3.1%, upper tertile) was associated with greater left ventricular dilatation (enddiastolic diameter, 67±8 vs. 63±7 mm, P<0.001). The cut-off for the absence of severe dilatation (enddiastolic diameter >70 mm) was set at >1.24% docosahexaenoic acid. In our sample, the negative predictive value for severe dilatation was 91% and sensitivity was 84%.

          Conclusions: Docosahexaenoic acid provides a new sensitive biomarker for monitoring and detecting severe left ventricular dilatation in heart failure patients.

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