Temporal Course of Plasma Trimethylamine N-Oxide (TMAO) Levels in ST-Elevation Myocardial Infarction.
Mohammad A AlmesnedFemke M PrinsErik LipšicMargery A ConnellyErwin GarciaRobin P F DullaartHilde E GrootPim van der HarstPublished in: Journal of clinical medicine (2021)
The gut metabolite trimethylamine N-oxide (TMAO) at admission has a prognostic value in ST-elevation myocardial infarction (STEMI) patients. However, its sequential changes and relationship with long-term infarct-related outcomes after primary percutaneous coronary intervention (PCI) remain elusive. We delineated the temporal course of TMAO and its relationship with infarct size and left ventricular ejection fraction (LVEF) post-PCI, adjusting for the estimated glomerular filtration rate (eGFR). We measured TMAO levels at admission, 24 h and 4 months post-PCI in 379 STEMI patients. Infarct size and LVEF were determined by cardiac magnetic resonance 4 months after PCI. TMAO levels decreased from admission (4.13 ± 4.37 μM) to 24 h (3.41 ± 5.84 μM, p = 0.001) and increased from 24 h to 4 months (3.70 ± 3.86 μM, p = 0.026). Higher TMAO values at 24 h were correlated to smaller infarct sizes (rho = -0.16, p = 0.024). Larger declines between admission and 4 months suggestively correlated with smaller infarct size, and larger TMAO increases between 24 h and 4 months were associated with larger infarct size (rho = -0.19, p = 0.008 and rho = -0.18, p = 0.019, respectively). Upon eGFR stratification using 90 mL/min/1.73 m2 as a cut-off, significant associations between TMAO and infarct size were only noted in subjects with impaired renal function. In conclusion, TMAO levels in post-PCI STEMI patients are prone to fluctuations, and these fluctuations could be prognostic for infarct size, particularly in patients with impaired renal function.
Keyphrases
- percutaneous coronary intervention
- st elevation myocardial infarction
- acute myocardial infarction
- ejection fraction
- st segment elevation myocardial infarction
- acute coronary syndrome
- coronary artery disease
- antiplatelet therapy
- end stage renal disease
- left ventricular
- coronary artery bypass grafting
- aortic stenosis
- magnetic resonance
- chronic kidney disease
- emergency department
- small cell lung cancer
- newly diagnosed
- atrial fibrillation
- prognostic factors
- peritoneal dialysis
- tyrosine kinase
- patient reported outcomes
- protein kinase
- mitral valve