Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Circ Cardiovasc Interv. 2019 Jan;12(1):e007281. doi: 10.1161/CIRCINTERVENTIONS.118.007281.
Trimethylamine N-oxide (TMAO) is reported to promote the pathogenesis of atherosclerosis and be associated with cardiovascular events risk. It is unknown whether plasma TMAO is associated with plaque morphology in patients with acute myocardial infarction. We investigated the relationship between the culprit plaque morphology and plasma TMAO concentration in patients with ST-segment-elevation myocardial infarction.
A prospective series of 211 patients with ST-segment-elevation myocardial infarction who underwent preintervention optical coherence tomography examination for the culprit lesion were enrolled; 77 and 69 patients were categorized as plaque rupture and plaque erosion, respectively. Plasma TMAO levels, detected using stable isotope dilution liquid chromatography tandem mass spectrometry, were significantly higher in patients with plaque rupture than in those with plaque erosion (3.33 μM; interquartile range: 2.48-4.57 versus 1.21 μM; interquartile range: 0.86-1.91; P<0.001). After adjustments for traditional risk factors, elevated TMAO levels remained independently correlated with plaque rupture (adjusted odds ratio: 4.06, 95% CI, 2.38-6.91; P<0.001). The area under the receiver operating characteristic curve for plaque rupture versus plaque erosion was 0.89. At a cutoff level of 1.95 μM, TMAO had a sensitivity of 88.3% and specificity of 76.8% in discriminating plaque rupture from plaque erosion.
High levels of plasma TMAO independently correlated with plaque rupture in patients with ST-segment-elevation myocardial infarction. Moreover, TMAO might be a useful biomarker for plaque rupture to improve risk stratification and management in patients with ST-segment-elevation myocardial infarction.
URL: https://www.clinicaltrials.gov . Unique identifiers: NCT03593928.
三甲基胺 N-氧化物（TMAO）据报道可促进动脉粥样硬化的发病机制，并与心血管事件风险相关。目前尚不清楚血浆 TMAO 是否与急性心肌梗死患者的斑块形态有关。我们研究了 ST 段抬高型心肌梗死患者罪犯斑块形态与血浆 TMAO 浓度之间的关系。
前瞻性纳入了 211 例接受罪犯病变术前光学相干断层扫描检查的 ST 段抬高型心肌梗死患者；77 例和 69 例患者分别归类为斑块破裂和斑块侵蚀。采用稳定同位素稀释液相色谱串联质谱法检测血浆 TMAO 水平，斑块破裂组患者的血浆 TMAO 水平明显高于斑块侵蚀组（3.33μM；四分位间距：2.48-4.57 比 1.21μM；四分位间距：0.86-1.91；P<0.001）。调整传统危险因素后，升高的 TMAO 水平仍与斑块破裂独立相关（调整优势比：4.06，95%可信区间：2.38-6.91；P<0.001）。斑块破裂与斑块侵蚀的受试者工作特征曲线下面积为 0.89。在截断值为 1.95μM 时，TMAO 对区分斑块破裂和斑块侵蚀的灵敏度为 88.3%，特异性为 76.8%。
在 ST 段抬高型心肌梗死患者中，高水平的血浆 TMAO 与斑块破裂独立相关。此外，TMAO 可能是一种有用的斑块破裂标志物，可改善 ST 段抬高型心肌梗死患者的风险分层和管理。
