A Step Towards a Non–Invasive Test for Monitoring Patients with Heart Failure

Researchers demonstrate the potential of using saliva analysis to predict flare-ups in people with heart failure, which could help them to live longer and better lives. 

At least 26 million people worldwide are currently living with heart failure – and these numbers are expected to increase dramatically in the future. 

When a person first develops heart failure, their body will undergo several physiological changes to try and compensate. But eventually, their body can no longer keep up and they start to experience symptoms such as shortness of breath and fatigue. Their condition will progressively worsen over time – and around four in ten patients will not survive for more than five years after their diagnosis.

A person living with heart failure may experience acute heart failure, which will often require hospital admission. If doctors could reliably predict an imminent flare-up, it may be possible to prevent it from happening – improving the quality of life for people living with heart failure and potentially lengthening their lives.

A Non–Invasive Test

In a new study, published in Scientific Reports, researchers carry out a pilot study to investigate the feasibility of monitoring patients with heart failure by testing their saliva.1

The researchers developed a new method to simultaneously measure the concentration of two potential biomarkers – 8–isoPGF2α and cortisol – in saliva. This involved combining microextraction by packed sorbent (MEPS) with ultra–high–performance liquid chromatography coupled to electrospray ionization triple–quadrupole mass spectrometry (UHPLC–ESI–MS/MS).

They demonstrated that this approach provided satisfactory recovery (95–110%) and an adequate detection limit (10pg/ml) in saliva samples. 

Monitoring Patients with Heart Failure

The team then carried out a pilot study on saliva samples from 44 patients with heart failure who were hospitalized due to a flare-up. They used validated procedures to monitor a panel of candidate biomarkers for heart failure – lactate, uric acid, TNF–α, cortisol, α–amylase and 8–isoPGF2α – collected at regular times during their stay.

They measured the concentration of TNF–α with an enzyme-linked immunosorbent assay (ELISA) using ultrapure water obtained from an ELGA PURELAB® laboratory water purification system, minimising the risk of introducing contaminants that may affect their results.

Their results identified that about 70% of patients showed at least a 3–fold decrease of two biomarkers – 8–isoPGF2α and lactate – in their saliva at the point of discharge from hospital, which is likely related to an improvement in clinical symptoms due to treatment. Assuming that high salivary concentrations of these two chemicals build up progressively over time in saliva, their monitoring may provide an early warning of acute heart failure.

Preventing Flare-Ups

This study identifies 8–isoPGF2α and lactate as possible non–invasive biomarkers for heart failure monitoring – and that saliva analysis has potential applications in clinical practice. 

If these biomarkers are validated in future studies, it could pave the way towards the development of new sensing devices that could be used at home to help prevent flare-ups in patients with heart failure – improving and possibly prolonging their lives. 

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Reference:

1. Ghimenti S., et al. Salivary lactate and 8–isoprostaglandin F2α as potential non–invasive biomarkers for monitoring heart failure: a pilot study. Sci Rep (2020):10;7441. https://doi.org/10.1038/s41598-020-64112-2

Dr Alison Halliday

After completing an undergraduate degree in Biochemistry & Genetics at Sheffield University, Alison was awarded a PhD in Human Molecular Genetics at the University of Newcastle. She carried out five years as a Senior Postdoctoral Research Fellow at UCL, investigating the genes involved in childhood obesity syndrome. Moving into science communications, she spent ten years at Cancer Research UK engaging the public about the charity’s work. She now specialises in writing about research across the life sciences, medicine and health.