What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Heart failure with preserved ejection fraction (HFpEF) (n=324). Intervention: Plasma trimethylamine n-oxide (TMAO) vs. Healthy controls. Primary outcome: Risk of HFpEF (OR 3.49, 95% CI 1.23-9.86, p=0.02).

August 28, 2020Open Access

Plasma trimethylamine n-oxide is associated with renal function in patients with heart failure with preserved ejection fraction

Resultado clave

Increased plasma TMAO levels were independently associated with a higher risk of HFpEF (OR 3.49) and renal dysfunction (OR 9.57) after adjustment for multiple traditional risk factors.

Diseño del estudio

Tipo

Cross-Sectional (n=324)

Multicéntrico

PICO estructurado

Are plasma TMAO levels associated with the presence of HFpEF and renal dysfunction?

Población

324 subjects comprising 228 patients with heart failure with preserved ejection fraction (HFpEF) and 96 healthy controls

Intervención

Plasma trimethylamine n-oxide (TMAO) measurement

Comparador

Healthy controls (for HFpEF evaluation) and normal renal function (for renal dysfunction evaluation)

Resultado

Association of TMAO levels with HFpEF and renal dysfunctionsurrogate

Plasma TMAO levels are elevated in HFpEF and independently associated with both the presence of HFpEF and concurrent renal dysfunction, suggesting its potential utility as a diagnostic biomarker.

Resultado numérico

Estimación del efecto: OR 3.49 (95% CI 1.23-9.86)

valor p: p=0.02

Limitaciones

Single center study, so selection bias cannot be excluded
Cross-sectional design prevents evaluation of the future influence of TMAO on the advance of HFpEF and its comorbidities
Did not include potential confounding factors such as patients' nutritional status, recent diet, and microbiota profile

Resumen

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is an emerging global health problem with less awareness. Renal dysfunction in HFpEF is associated with worse outcome. However, there is lack of rapid, noninvasive and accurate method for risk stratification in HFpEF and renal dysfunction. This study aimed to explore the utility of plasma trimethylamine n-oxide (TMAO) for evaluation of HFpEF and renal function. METHODS: Plasma TMAO levels were measured in total 324 subjects comprising 228 HFpEF patients and 96 healthy controls. RESULTS: ) (14.18(10.4-23.06) μg/l vs 10.9(7.48-15.47) μg/l, p < 0.01). Increased TMAO levels were independently associated with higher risk of HFpEF (OR = 3.49, 95% CI: 1.23-9.86, p = 0.02) and renal dysfunction (OR = 9.57, 95% CI: 2.11-43.34, p < 0.01) after adjustment for multiple traditional risk factors. Furthermore, TMAO had good performance at distinguishing HFpEF from controls (AUC = 0.63, p < 0.01), and renal dysfunction from normal renal function in HFpEF (AUC = 0.67, p < 0.01). CONCLUSION: In this cross-sectional study, HFpEF and renal function were closely related with plasma TMAO levels and TMAO may serve as a diagnostic biomarker for HFpEF and renal function.

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