To Ascertain the Utility of Urinary Methyl Malonic Acid as a Potential Marker of Ischemic Heart Failure

Abstract

Background: Methyl Malonic Acid (MMA) is known to be an integral component of the cascade of events in mitochondrial energy metabolism and since heart failure involves energy pathways, it is probable that levels of MMA could be used as a reliable biomarker to objectively identify the disease during the early stages and help in prognostication. Materials and Methods: The present study was envisaged to evaluate the relation between urinary MMA levels in patients with Ischemic heart disease and in those progressing to failure. The relationship between the severity of the disease and the level of MMA in urine were also evaluated. Analysis of urinary MMA was done by Gas Chromatography-Mass Spectrometry (GC-MS) using stable isotope dilution. Twenty patients each with Ischemic Heart Disease, heart failure and controls were recruited in this pilot study. Results: The mean value of MMA in patients with IHD was 126.71(±66.3) pmol/L and those with IHF was 390.76 (±97.99) pmol/L with the difference being statistically significant (p<0.001). Co-existing B12 deficiency was excluded as that was a potential confounder. Conclusion: Levels of MMA were significantly higher in patients with heart failure compared to those with IHF, which were significantly higher than controls. Evaluation of the correlation between MMA levels and the stage of the disease did not reach statistical significance; but this requires adequately powered studies to support this preliminary finding.

Keywords

• gas chromatography-mass spectrometry (gc-ms)
• heart failure
• ischemic heart disease
• methyl malonic acid (mma)
• vitamin b12 deficiency