Plasma and pericardial fluid metabolomic signatures of patients with ischemic heart disease

Ischemic heart disease is the leading cause of global mortality. Despite advances in clinical management, current diagnostic tools do not capture early metabolic disturbances associated with myocardial ischemia. Understanding these alterations may provide new insights into disease mechanisms. A metabolomic approach based on magnetic resonance spectroscopy is used to characterize the metabolic profile of patients with ischemic heart disease compared with non-ischemic individuals. Plasma and pericardial fluid collected during cardiac surgery are analyzed to investigate both systemic and heart-proximal molecular changes. Small-molecule concentrations are quantified and statistically evaluated to identify metabolic differences associated with ischemia. Here we show that ischemic heart disease is associated with a distinct metabolic pattern. We observe increased concentrations of 3-hydroxybutyrate in both biological fluids, together with elevated succinate in pericardial fluid, indicating alterations in mitochondrial energy metabolism. Additional changes involve pathways linked to substrate utilization and redox balance. These findings highlight a metabolic response to myocardial ischemia detectable in both systemic and locally collected fluids. The identified alterations offer a deeper understanding of the biochemical environment associated with ischemic heart disease. Ischemic heart disease happens when the heart does not receive enough blood and oxygen. It is one of the main causes of death around the world. To better understand what happens inside the heart during this condition, we studied small molecules found in blood and in the fluid surrounding the heart during surgery. These molecules, called metabolites, help us understand how the body produces and uses energy. We found specific changes in these molecules in people with ischemic heart disease. In particular, we observed signs that heart cells may switch to different energy sources when oxygen is low. These results help us better understand what happens during heart damage and may support future research aimed at improving early detection and patient care. De Castro, Coppola et al. analyze metabolic profiles in blood and pericardial fluid from patients with ischemic heart disease. They identify distinct energy-related changes that reflect myocardial stress and may support improved understanding of ischemia.