Aleksova Aneta, Fluca Alessandra Lucia, Stornaiuolo Mariano, Barbati Giulia, Pierri Alessandro, Zwas Donna R, Santon Daniela, D'Errico Stefano, Marketou Maria, Sinagra Gianfranco, Avraham Yosefa, Novellino Ettore, Janjusevic Milijana
Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy.
Azienda Sanitaria Universitaria Giuliano Isontina, Cardiothoracovascular Department, Trieste, Italy; Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy.
Hellenic J Cardiol. 2024 May 9. doi: 10.1016/j.hjc.2024.05.007.
Trimethylamine N-oxide (TMAO) has been associated with atherosclerosis and poor outcome. We evaluated the prognostic impact of intra-hospital TMAO variation on patient outcome.
Blood samples from 149 patients with acute myocardial infarction (AMI) were taken on admission and discharge. Plasma TMAO was determined by HPLC-MS. The endpoint was a composite three-point MACE (major adverse cardiovascular events), including all-cause mortality, re-infarction, or heart failure (HF) development. Median TMAO concentration on admission was significantly higher than on discharge (respectively, 7.81 [3.47-19.98] vs 3.45 [2.3-4.78] μM, p < 0.001). After estimating the 3.45 μM TMAO cut-off with the analysis of the continuous hazard ratio, we divided our cohort into two groups. The first group included 75 (50.3%) patients whose TMAO levels remained below or decreased under cut-off (low-low/high-low; LL/HL), while the second group included 74 (49.7%) patients whose TMAO levels remained high or increased above the cut-off during hospitalisation (high-high/low-high; HH/LH). During the median 30-month follow-up, 21.5% of patients experienced the composite endpoint. At Kaplan-Meier analysis, a trend of increasing MACE risk was observed in patients in the HH/LH group (p = 0.05). At multivariable Cox analysis, patients from the HH/LH group had more than two times higher risk of MACE during the follow-up than the LL/HL group (HR = 2.15 [95% CI, 1.03-4.5], p = 0.04). Other independent predictors of MACE were older age and worse left ventricular systolic function.
In patients with AMI, permanently high or increasing TMAO levels during hospitalisation are associated with a higher risk of MACE during long-term follow-up.
氧化三甲胺（TMAO）与动脉粥样硬化及不良预后相关。我们评估了住院期间TMAO变化对患者预后的影响。
采集149例急性心肌梗死（AMI）患者入院时及出院时的血样。采用高效液相色谱-质谱法测定血浆TMAO。终点为复合三点主要不良心血管事件（MACE），包括全因死亡率、再梗死或心力衰竭（HF）发生。入院时TMAO浓度中位数显著高于出院时（分别为7.81[3.47 - 19.98]μM和3.45[2.3 - 4.78]μM，p < 0.001）。通过连续风险比分析估计3.45μM的TMAO临界值后，我们将队列分为两组。第一组包括75例（50.3%）患者，其TMAO水平在临界值以下或下降（低-低/高-低；LL/HL），而第二组包括74例（49.7%）患者，其TMAO水平在住院期间持续高于临界值或升高（高-高/低-高；HH/LH）。在中位30个月的随访期间，21.5%的患者发生了复合终点事件。在Kaplan-Meier分析中，HH/LH组患者的MACE风险有增加趋势（p = 0.05）。在多变量Cox分析中，HH/LH组患者在随访期间发生MACE的风险比LL/HL组高两倍多（HR = 2.15[95%CI，1.03 - 4.5]，p = 0.04）。MACE的其他独立预测因素为年龄较大和左心室收缩功能较差。
在AMI患者中，住院期间TMAO水平持续升高或上升与长期随访期间较高的MACE风险相关。
