Trimethylamine N-oxide and prognosis in acute heart failure
Open accessAbstract
Objective: Acute heart failure (AHF) is associated with high mortality and morbidity. Trimethylamine N-oxide (TMAO), a gut-derived metabolite, has reported association with mortality risk in chronic HF but this association in AHF is still unknown. The present study investigated TMAO in patients admitted to hospital with AHF, and association of circulating levels with prognosis. Methods: In total, 972 plasma samples were analysed for TMAO concentration by liquid chromatography-mass spectrometry. Associations with in-hospital mortality (72 events), all-cause mortality (death, 268 events) and a composite of death or rehospitalisation due to HF (death/HF, 384 events) at 1 year were examined. Results: TMAO improved risk stratification for in-hospital mortality in combination with current clinical scorings (OR≥1.13, p≤0.014). TMAO tertile analyses reported a graded risk in adverse outcome within 1 year (OR≥1.61, p≤0.004) and improved outcome prediction when stratified as none, one or both biomarker(s) elevated in combination with N-terminal pro B-type natriuretic peptide (NT-proBNP) (OR≥2.15, p≤0.007). TMAO was independently predictive for death and death/HF when corrected for cardiac risk factors (HR≥1.16, p≤0.037); however, this ability was weakened when indices of renal function were included, possibly due to multicollinearity. Conclusions: TMAO contributed additional information on patient stratification for in-hospital mortality of AHF admissions using available clinical scores that include renal indices. Furthermore, elevated levels were associated with poor prognosis at 1 year and combination of TMAO and NT-proBNP provided additional prognostic information. TMAO was a univariate predictor of death and death/HF, and remained an independent predictor until adjusted for renal confounders.
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Removal of the TMAO diet after TAC resulted in greater myocardial recovery in mice.
“Furthermore, in separate studies, it is reported that removal of the TMAO diet after TAC resulted in a greater myocardial recovery in the mice179.”
From Dietary metabolism, the gut microbiome, and heart failure (2019) · cites this paper as [179]
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- Authors
- Suzuki, T., Heaney, L. M., Bhandari, S. S., Jones, D. J. L., & Ng, L. L.
- Affiliations
- University of Leicester (GB)
- Glenfield Hospital (GB)
- Corresponding author
- Suzuki, Toru
- Venue
- Heart
- Publisher
- BMJ
- Published
- 2016-02-11
- Volume
- 102
- Issue
- 11
- Pages
- 841-848
- ISSN
- 1355-6037 (ISSN-L)
- 1468-201X
- OpenAlex
- W2282801396
- Cited by
- 253
- References
- 30
- Citations by year
- 2026: 8 · 2025: 23 · 2024: 15 · 2023: 25 · 2022: 30 · 2021: 43 · 2020: 24 · 2019: 31 · 2018: 27 · 2017: 19 · 2016: 8
- FWCI
- 23.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Heart (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institute for Health and Care Research
- British Heart Foundation (FS/12/30/29474)
- John and Lucille Van Geest Foundation
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- trimethylamine N-oxide, acute heart failure, prognosis, in-hospital mortality, NT-proBNP, gut microbiota metabolites, risk stratification, all-cause mortality, hospital readmission, biomarkers
- MeSH terms
- Acute Disease, Aged, Aged, 80 and over, Chromatography, Liquid, Female, Heart Failure, Humans, Male, Methylamines, Patient Readmission, Peptide Fragments, Predictive Value of Tests, Prognosis, Risk Factors, Mass Spectrometry, Time Factors, Biomarkers, Up-Regulation, Multivariate Analysis, Chi-Square Distribution, Logistic Models, Proportional Hazards Models, Odds Ratio, Hospital Mortality, Risk Assessment, Natriuretic Peptide, Brain
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