Journal Article

Higher circulating Trimethylamine N-oxide levels are associated with worse severity and prognosis in pulmonary hypertension: a cohort study

Xue, Lin, Luo, Qin, Yang, Beilan, Yang, Yicheng, Liu, Bingyang, Zhao, Zhihui, Zeng, Qixian, Liang, Yanru, Liu, Zhihong, Xiong, Changming, Li, Xin

2022

Overview

Background Trimethylamine N-oxide (TMAO), the gut microbiota-dependent metabolite, is a potential biomarker in several cardiovascular diseases. However, no study has investigated its value in pulmonary hypertension (PH). Therefore, this study aimed to explore the association between plasma TMAO levels and prognosis in patients with PH. Methods Inpatients with idiopathic/heritable pulmonary arterial hypertension (IPAH/HPAH), PAH associated with congenital heart disease (CHD-PAH), and chronic thromboembolic pulmonary hypertension (CTEPH) at Fuwai Hospital were enrolled after excluding those with relative comorbidities. The endpoint was defined as a composite outcome including death, rehospitalisation due to heart failure, and at least 15% decreased 6-min walk distance from the baseline. Fasting blood samples were collected to measure plasma levels of TMAO and other clinical indicators. The associations between TMAO levels with disease severity and patients’ prognosis were investigated. Results In total, 163 patients with PH were included, with a mean follow-up duration of 1.3 years. After adjusting for confounding factors, elevated TMAO levels were still associated with severe disease conditions. TMAO levels dynamically decreased in stable and improved patients after treatment [ΔTMAO = − 0.2 (− 1.6, 0.7) μmol/L, P  = 0.006]. Moreover, high plasma TMAO levels predicted a poor prognosis in the PH cohort ( P  < 0.001), and the association remained significant after adjusting the confounders, including treatment, risk stratification, and PH subtypes. Conclusion Elevated plasma TMAO levels were associated with severe disease conditions and poor prognosis in patients with PH, indicating its potential biomarker role in PH.

• Publisher: BioMed Central,BioMed Central Ltd,Nature Publishing Group,BMC
• Subject: Biomarker / Biomarkers / Cardiology / Cardiovascular diseases / Cohort analysis / Cohort Studies / Comorbidity / Complications and side effects / Congestive heart failure / Disease / Fasting / Health aspects / Health services / Heart diseases / Heart failure / Humans / Hypertension / Hypertension, Pulmonary - diagnosis / Intestinal microflora / Measurement / Medicine / Medicine & Public Health / Metabolism / Metabolites / Pathogenesis / Patient Acuity / Patients / Plasma / Plasma levels / Pneumology/Respiratory System / Prognosis / Pulmonary hypertension / Risk Factors / Thromboembolism / Trimethylamine / Trimethylamine N-oxide