Abstract 10196: Reducing Symptom Burden Using Ubiquinol And/Or D-Ribose in Patients With Heart Failure With Preserved Ejection Fraction

Abstract

Introduction: Mitochondrial dysfunction has been implicated in the development of HFpEF, particularly a decrease in the production of adenosine triphosphate (ATP). Ubiquinol is produced in the mitochondria and is required for oxidative phosphorylation and D-ribose is an essential component of ATP. Thus, supplementing with ubiquinol and/or D-ribose could be useful to improve mitochondrial biomechanics and patient symptoms. Hypothesis: To determine if ubiquinol and/or D-ribose would reduce the symptoms and improve cardiac performance in patients with HFpEF. Methods: This study was a randomized, double-blind, placebo-controlled trial of 216 patients with HFpEF. Four study groups received various supplements over 12 weeks: Group 1 - placebo capsules and placebo powder (placebo group); Group 2 - ubiquinol (600 mg/day) and placebo D-ribose; Group 3 - placebo ubiquinol with D-ribose (15 g/day); Group 4 - ubiquinol (600 mg/day) and D-ribose (15 g/day). There were seven outcome measures for this study: Kansas City Cardiomyopathy Questionnaire (KCCQ) clinical summary score (CSS), level of vigor using a subscale from the Profile of Mood States (POMS), ejection fraction (EF), the ratio of mitral peak velocity of early filling (E) to early diastolic mitral annular velocity (eꞌ) (septal E/eꞌ ratio), B-type natriuretic peptides (BNP), lactate/ATP ratio, and the 6-minute walk test (6MWT). Results: Using ubiquinol and/or D-ribose significantly increased the KCCQ clinical summary score (17.30 to 25.82 points [compared to Group 1, p = 0.0001 (Group 2); p < 0.0001 (Group 3); p=0.0116 (Group 4)], vigor score (7.65 to 8.15 points [all p < 0.0001]), EF (7.08 to 8.03% [p = 0.0006; p < 0.0001; p = 0.0002]), and decreased BNP (-72.02 to -47.51 pg/mL [p = 0.0002; p = 0.0024; p = 0.0415]) and lactate/ATP ratio (-4.32x10 -4 to -3.35x10 -4 mmol/L/RLU) [p < 0.0001; p < 0.0001; p = 0.0006]). We found no significant improvement in septal E/e’ or 6MWT. Conclusions: The use of ubiquinol and/or D-ribose significantly decreased the patients’ symptoms of HFpEF and improved EF. This suggests that the ubiquinol and/or D-ribose increased mitochondrial function by increasing cellular ATP & may help reduce symptom burden and improve cardiac function. NIH: 1R01AG054486-01A1, NCT03133793, IND: 134633