Abstract Tu113: Metabolomic Profile of Human End-Stage Ischemic Cardiomyopathy Reveals Few Differences from Non-Ischemic Cardiomyopathy

Background: The heart is highly metabolic, relying on a range of fuels to sustain its high generation of ATP. The primary source of energy in the human heart is fatty acids, but fatty acid oxidation is reduced in failing hearts, contributing to a decrease in ATP production. Previously, we provided a comprehensive metabolic profile of human non-ischemic cardiomyopathy (NICM) hearts, including maintained ATP levels despite decreased energy charge (EC), lower acylcarnitines, acyl CoAs, and free fatty acids, suggesting a defect in fatty acid import. Research Questions: The pathogenesis of ischemic cardiomyopathy (ICM) is dramatically different from that of NICM, raising the question of whether metabolic defects differ between these two conditions. Aims: Our current study was therefore aimed at elucidating the metabolomic profile of end-stage ICM compared to that of NICM. Methods: Whole human hearts were obtained either from patients with end-stage heart failure (NICM or ICM) undergoing cardiac transplantation or from brain-dead organ donors. Hearts were arrested in situ and kept in ice-cold cardioplegia solution at all times. Transmural tissue samples were obtained from left ventricular free wall, snap frozen, and extracted metabolites were quantified by liquid chromatography coupled with mass spectrometer. Results: The comparison of metabolomics data from non-failing (NF) control heart samples and NICM samples were consistent with our previous study, with marked decrease in acylcarnitines and increase in lysophosphatidylcholine. On the other hand, the metabolomics profiles of ICM and NICM samples were remarkably similar. Phenylacetylglutamine and trimethylamine N-oxide, both related to atherosclerotic disease risk, were statistically significantly higher in ICM samples compared to NICM samples. Conclusion(s): The human cardiac metabolome of end-stage ICM is nearly identical to that of NICM, despite dramatically different pathogeneses, suggesting that end-stage heart failure constitutes a final common pathway. It would be of great interest to evaluate metabolomic profiles of the diseases differ at earlier timepoints.