Exhaled Acetone as a New Biomarker of Heart Failure Severity Fabiana G. Marcondes-Braga, MD, PhD, Ivano G.R. Gutz, PhD, Guilherme L. Batista, MSc, Paulo H.N. Saldiva, MD, PhD, Silvia M. Ayub-Ferreira, MD, PhD, Victor S. Issa, MD, PhD, Sandrigo Mangini, MD, Edimar A Bocchi, MD, PhD, Fernando Bacal, MD, PhD  CHEST  Volume 142, Issue 2, Pages 457-466 (August 2012) DOI: 10.1378/chest.11-2892 Copyright © 2012 The American College of Chest Physicians Terms and Conditions

Figure 1 Study design. ADHF = acute decompensated heart failure; CHF = chronic heart failure; CPT = cardiopulmonary test; CRF = chronic renal failure; EF = ejection fraction; GC-MS = gas chromatography-mass spectrometry; HF = heart failure; w/o = without. CHEST 2012 142, 457-466DOI: (10.1378/chest.11-2892) Copyright © 2012 The American College of Chest Physicians Terms and Conditions

Figure 2 EBA and BNP levels in the diagnosis of CHF and ADHF. A, Median EBA concentration for CHF group. B, Median BNP concentration for CHF group. EBA and BNP concentrations were significantly higher in HF group than in the control group. C, Median EBA concentration for the ADHF group. D, Median BNP concentration for the ADHF group. EBA and BNP concentrations were significantly higher in the ADHF group than in the CHF group. Boxes show interquartile ranges, and bars represent highest and lowest values. CHEST 2012 142, 457-466DOI: (10.1378/chest.11-2892) Copyright © 2012 The American College of Chest Physicians Terms and Conditions

Figure 3 Receiver operating characteristic (ROC) curves for the diagnosis of chronic HF and ADHF. A, ROC curves for EBA and BNP to diagnose HF. B, ROC curves for EBA and BNP to differentiate chronic HF from ADHF. AUC = area under the curve. See Figure 1 and 2 legends for expansion of other abbreviations. CHEST 2012 142, 457-466DOI: (10.1378/chest.11-2892) Copyright © 2012 The American College of Chest Physicians Terms and Conditions

Figure 4 Median EBA concentration in patients with HF expressed as a function of NYHA symptom severity. Boxes show interquartile ranges, and bars represent highest and lowest values. NYHA = New York Heart Association. See Figure 1 and 2 legends for expansion of other abbreviation. CHEST 2012 142, 457-466DOI: (10.1378/chest.11-2892) Copyright © 2012 The American College of Chest Physicians Terms and Conditions

Figure 5 Correlation between EBA and BNP concentrations. See Figure 2 legend for expansion of abbreviations. CHEST 2012 142, 457-466DOI: (10.1378/chest.11-2892) Copyright © 2012 The American College of Chest Physicians Terms and Conditions