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Plasma and pericardial fluid metabolomic signatures of patients with ischemic heart disease
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  • Published: 21 January 2026

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

  • Federica De Castro  ORCID: orcid.org/0000-0001-5060-293X1 na1,
  • Chiara Coppola2 na1,
  • Egeria Scoditti  ORCID: orcid.org/0000-0003-2753-84873,
  • Giuseppe Santarpino4,5,6,
  • Stefania Marazia  ORCID: orcid.org/0000-0003-4456-53727,
  • Francesco Paolo Fanizzi1 &
  • …
  • Michele Maffia  ORCID: orcid.org/0000-0003-0665-45348,9 

Communications Medicine , Article number:  (2026) Cite this article

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We are providing an unedited version of this manuscript to give early access to its findings. Before final publication, the manuscript will undergo further editing. Please note there may be errors present which affect the content, and all legal disclaimers apply.

Subjects

  • Diagnostic markers
  • Heart failure

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Plain language summary

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.

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Data availability

All the metabolomic data used to generate the here presented statistical models and figures are available as Supplementary Data.

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Acknowledgements

This research was financially supported by the POS Salute 2014–2020 of the Italian Ministry of Health, under Trajectory 3 “Regenerative, Predictive and Personalized Medicine”, Action Line 3.1, within the project “Integrated Health and Genetics System for Cardiovascular Diseases (SISAGEN-CARDIO)” (local project code T3-AN-18).

Author information

Author notes

  1. These authors contributed equally: Federica De Castro, Chiara Coppola.

Authors and Affiliations

  1. Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, Via Monteroni, Lecce, Italy

    Federica De Castro & Francesco Paolo Fanizzi

  2. Department of Mathematics and Physics “E. De Giorgi”, University of Salento, Via Lecce—Arnesano, Lecce, Italy

    Chiara Coppola

  3. Institute of Clinical Physiology (IFC), National Research Council (CNR), Lecce, Italy

    Egeria Scoditti

  4. Department of Cardiac Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy

    Giuseppe Santarpino

  5. Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy

    Giuseppe Santarpino

  6. Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany

    Giuseppe Santarpino

  7. Department of Cardiology, PO Fazzi, ASL_LE, Piazzale Muratore, Lecce, Italy

    Stefania Marazia

  8. Department of Experimental Medicine, University of Salento, Lecce, Via, Monteroni, Italy

    Michele Maffia

  9. Lab of Clinical Proteomic, PO Fazzi, ASL_LE Piazzale Muratore, Lecce, Italy

    Michele Maffia

Authors
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Contributions

F.D.C., C.C., M.M.: Conceptualization; F.D.C., C.C., E.S.:formal analysis, data curation, investigation; F.D.C., C.C., E.S. writing-original draft, F.D.C.: performed metabolomic analysis; C.C., E.S., G.S., S.M., M.M.: contributed patient samples and clinical data; F.D.C., C.C., E.S., M.M., F.P.F.: writing-reviewing and editing; F.P.F., M.M.: Supervision, Funding acquisition. All authors have read and agreed to the published.

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Correspondence to Michele Maffia.

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De Castro, F., Coppola, C., Scoditti, E. et al. Plasma and pericardial fluid metabolomic signatures of patients with ischemic heart disease. Commun Med (2026). https://doi.org/10.1038/s43856-025-01353-0

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  • Received: 29 April 2025

  • Accepted: 19 December 2025

  • Published: 21 January 2026

  • DOI: https://doi.org/10.1038/s43856-025-01353-0

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