Associations among serum trimethylamine-N-oxide (TMAO) levels, kidney function and infarcted coronary artery number in patients undergoing cardiovascular surgery: a cross-sectional study
Open accessAbstract
BACKGROUND: Trimethylamine-N-oxide (TMAO) is a metabolite of phosphatidylcholine generated by gut microbiota and liver enzymes, and has recently been recognized as contributing to atherosclerosis. Elevated serum TMAO levels have been shown to increase the risk of cardiovascular disease (sudden death, myocardial infarction, or stroke) in patients undergoing elective coronary angiography. We aimed to clarify whether TMAO levels are associated with the number of infarcted coronary arteries as a measure of the severity of atherosclerosis, with adjustment using a priori-defined covariates such as kidney function. METHODS: By conducting a cross-sectional study of 227 patients who underwent cardiovascular surgery for coronary artery disease, valvular heart disease, or aortic disease, the association between serum TMAO levels as measured by HPLC-APCI-MS/MS and the number of infarcted coronary arteries was evaluated using ordered logistic regression models with adjustment of 10 covariates, including chronic kidney disease (CKD) stage. Unadjusted and adjusted odds ratios (ORs) and 95 % confidence intervals (95 % CIs) were determined. RESULTS: Significantly higher TMAO levels were observed in advanced-stage CKD (p ≤ 0.001). In fully adjusted models with the 10 covariates, a significantly increased number of infarcted coronary arteries was identified in the highest quartile and quintile of TMAO compared to the lowest quartile (OR 11.9; 95 % CI 3.88-36.7, p ≤ 0.001) and quintile (OR 14.1; 95 % CI 3.88-51.2; p ≤ 0.001), respectively, independent of dyslipidemia. CONCLUSIONS: Higher serum TMAO levels may be associated with advanced CKD stages and with an increased number of infarcted coronary arteries in patients who undergo cardiovascular surgery.
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In 227 patients who had cardiovascular surgery for coronary, valvular, or aortic disease, the highest quartile of plasma TMAO had a significantly greater number of infarcted coronary arteries than the lowest quartile (OR 11.9, 95% CI 3.88-36.7, p≤0.001).
“In a cross-sectional study of 227 patients who underwent cardiovascular surgery for coronary artery disease, valvular heart disease, or aortic disease, a significantly increased number of infarcted coronary arteries was identified in patients in the highest quartile of plasma TMAO concentrations compared to the lowest quartile (odds ratio 11.9; 95% confidence interval 3.88-36.7,p value ≤ 0.001) (”
From Trimethylamine <i>N</i> -Oxide, the Microbiome, and Heart and Kidney Disease (2017) · cites this paper as [72]
In CKD patients who underwent cardiovascular surgery (n = 227), elevated TMAO levels were observed.
“A cross-sectional study by Aki Mafune et al. observed elevated TMAO levels in CKD patients who underwent cardiovascular surgery (n = 227) [47].”
From Trimethylamine N-oxide: the good, the bad and the unknown. (2016) · cites this paper as [47]
Patients with the highest levels of TMAO had a higher number of infarcted coronary arteries compared to those with the lowest levels.
“Patients with the highest levels of TMAO had a higher number of infarcted coronary arteries compared to those with the lowest levels [47].”
From Trimethylamine N-oxide: the good, the bad and the unknown. (2016) · cites this paper as [47]
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- Authors
- Mafune, A., Iwamoto, T., Tsutsumi, Y., Nakashima, A., Yamamoto, I., Yokoyama, K., Yokoo, T., & Urashima, M.
- Affiliations
- Jikei University School of Medicine (JP)
- Corresponding author
- Urashima, Mitsuyoshi
- ORCID
- Venue
- Clinical and Experimental Nephrology
- Published
- 2015-12-16
- Volume
- 20
- Issue
- 5
- Pages
- 731-739
- ISSN
- 1342-1751 (ISSN-L)
- 1437-7799
- PMC
- PMC5050242
- OpenAlex
- W2201315038
- Cited by
- 103
- References
- 32
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 2 · 2023: 12 · 2022: 15 · 2021: 15 · 2020: 12 · 2019: 8 · 2018: 7 · 2017: 12 · 2016: 5
- FWCI
- 3.47
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Clinical and Experimental Nephrology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Life Sciences › Immunology and Microbiology › Immunology › Atherosclerosis and Cardiovascular Diseases
- Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
- Keywords
- trimethylamine N-oxide, chronic kidney disease, renal function, atherosclerosis severity, cardiovascular surgery, gut microbiota, phosphatidylcholine metabolism, coronary artery disease, valvular heart disease, aortic disease
- MeSH terms
- Aged, Chromatography, High Pressure Liquid, Coronary Artery Disease, Cross-Sectional Studies, Female, Cardiac Surgical Procedures, Humans, Kidney, Male, Methylamines, Middle Aged, Risk Factors, Severity of Illness Index, Vascular Surgical Procedures, Biomarkers, Up-Regulation, Chi-Square Distribution, Linear Models, Logistic Models, Odds Ratio, Renal Insufficiency, Chronic, Tandem Mass Spectrometry
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