Tsai Tsung-Ying, Aldujeli Ali, Haq Ayman, Murphy Paddy, Unikas Ramunas, Sharif Faisal, Garg Scot, Brilakis Emmanouil S, Onuma Yoshinobu, Serruys Patrick W
CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, H91 TK33 Galway, Ireland.
Cardiovascular Center, Taichung Veterans General Hospital, Taichung 407219, Taiwan.
Int J Mol Sci. 2025 Apr 5;26(7):3400. doi: 10.3390/ijms26073400.
Despite successful primary percutaneous coronary intervention (PPCI), the incidence of heart failure (HF) following ST-elevation myocardial infarction (STEMI) remains high. We investigated using Trimethylamine N-oxide (TMAO), a gut microbiota-derived biomarker, to predict adverse functional left ventricular (LV) remodeling (FLVR) and/or diastolic dysfunction (DD), which are precursors of HF post-STEMI. This prospective, observational study enrolled 204 STEMI patients with multivessel coronary artery disease after PPCI. TMAO level was collected at the baseline and 3 months. An echocardiography was performed at the baseline and at 12 months. The primary endpoints were the number of patients developing Group 4 FLVR or ≥Grade II DD at 12 months. The median age was 65 [57.00, 76.00] and 39.7% were women. The primary endpoints occurred in 47 (23.0%) patients. Three months of TMAO can discriminate patients with/without ≥Grade II LV DD and FLVR Grade 4 with areas under the curve (AUC) of the ROC of 0.72 (95% CI: 0.63-0.81; < 0.001) and 0.77 (95% CI: 0.63-0.91), respectively. Similar results were shown in the validation cohort of 31 patients. The addition of 3 months of TMAO to traditional risk factors significantly improved the AUCs from 0.675 to 0.736 for ≥Grade II DD and from 0.793 to 0.873 for FLVR Grade 4. In multivariable logistic regression, 3 months of TMAO was independently associated with ≥Grade II DD (OR: 1.29 (1.13-1.50), < 0.001) and FLVR Grade 4 (OR: 1.28 (1.12-1.47), < 0.001). Three months of TMAO is strongly associated with LV DD and adverse remodeling after STEMI and may help identifying such patients for early treatment.
尽管直接经皮冠状动脉介入治疗（PPCI）取得了成功，但ST段抬高型心肌梗死（STEMI）后心力衰竭（HF）的发生率仍然很高。我们研究了使用三甲胺N-氧化物（TMAO）这种肠道微生物群衍生的生物标志物来预测左心室（LV）不良功能重塑（FLVR）和/或舒张功能障碍（DD），它们是STEMI后HF的先兆。这项前瞻性观察性研究纳入了204例PPCI术后患有多支冠状动脉疾病的STEMI患者。在基线和3个月时收集TMAO水平。在基线和12个月时进行超声心动图检查。主要终点是在12个月时出现4级FLVR或≥II级DD的患者数量。中位年龄为65岁[57.00, 76.00]，女性占39.7%。主要终点发生在47例（23.0%）患者中。3个月时的TMAO能够区分有无≥II级LV DD和4级FLVR的患者，其ROC曲线下面积（AUC）分别为0.72（95%CI：0.63 - 0.81；<0.001）和0.77（95%CI：0.63 - 0.91）。在31例患者的验证队列中也显示了类似结果。将3个月时的TMAO添加到传统危险因素中，对于≥II级DD，AUC从0.675显著提高到0.736，对于4级FLVR，AUC从0.793显著提高到0.873。在多变量逻辑回归中，3个月时的TMAO与≥II级DD（OR：1.29（1.13 - 1.50），<0.001）和4级FLVR（OR：1.28（1.12 - 1.47），<0.001）独立相关。3个月时的TMAO与STEMI后的LV DD和不良重塑密切相关，可能有助于识别此类患者以便早期治疗。
