In a cohort of 1208 patients with chronic heart failure after myocardial infarction, elevated levels were associated with a hazard ratio of 2.31 for .
TMAO levels were higher in older patients with histories of atrial fibrillation and diabetes.
Cox regression analysis indicated a significant predictive value of TMAO for major adverse cardiac events (MACE) after adjusting for traditional risk factors.
The risk of MACE increased with higher TMAO levels, particularly when levels exceeded the median.
TMAO was also identified as an independent predictor of all-cause mortality with a hazard ratio of 2.15 after adjustment for conventional risk factors.
Simplified
AIM: Accumulating evidence has demonstrated that intestinal microbiota-dependent (TMAO) is involved in the pathogenesis of various cardiovascular diseases. The present study was designed to investigate the prognostic value of TMAO in patients with chronic heart failure (CHF) after myocardial infarction (MI).
METHODS AND RESULTS: We included 1208 CHF patients after MI in a prospective cohort study and determined the association between plasma TMAO and cardiovascular outcomes using Cox regression analysis. Patients with elevated TMAO levels were more likely to be older and have histories of atrial fibrillation and diabetes. Cox regression analysis indicated that TMAO was a significant predictor of (MACE) (hazard ratio = 2.31, 95% confidence interval 1.42-3.59, P < 0.01) following adjustment for conventional risk factors. Integrated discrimination and net reclassification improvements for MACE were markedly improved by addition of TMAO to the model of traditional risk factors. The Kaplan-Meier survival analysis showed that MACE risk increased with the elevation in TMAO levels and this positive correlation became more significant when TMAO levels were higher than the median. TMAO was also found to be an independent predictor of all-cause mortality (hazard ratio = 2.15, 95% confidence interval 1.37-3.24, P < 0.01) after adjusting for traditional risk factors.
CONCLUSIONS: Our study suggests that TMAO is a valuable prognostic indicator of MACE in patients with CHF after MI.
Key numbers
2.31
Hazard Ratio for
Adjusted for traditional risk factors in CHF patients after MI
12.6%
Integrated Discrimination Improvement (IDI)
Enhancement in risk prediction accuracy
2.15
Hazard Ratio for All-Cause Mortality
Adjusted for conventional risk factors
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