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Accumulation of intestinal microbial-dependent dietary phosphatidylcholine metabolite, trimethylamine N-oxide (TMAO), has been associated with coronary artery disease (CAD) pathogenesis. Potential pathophysiologic contributions of intestinal microflora in heart failure (HF) have not been described.
We examined the relationship between fasting plasma TMAO and all-cause mortality over 5-year follow-up in 720 stable subjects with history of HF.
In our study cohort (mean age 66±10 years, 41% women, median BNP 294 [IQR 114-658]pg/ml), median TMAO level was 5.0 (IQR 3.0-8.5) ??, which was higher than in the non-HF cohort (3.5 [IQR 2.3-5.7]??, p<0.001). There was only modest correlation between TMAO and BNP (r=0.23, p<0.001). Higher (4th vs 1st quartile) plasma TMAO level was associated with a 3.4-fold increased mortality risk. Following adjustments for traditional risk factors and BNP, elevated TMAO levels remained predictive of 5-year mortality risk (Hazard ratio [HR] 2.2 [95%CI 1.42-3.43], p<0.001, Figure) including addition of eGFR to the model (HR 1.75 [95%CI 1.07-2.86], p<0.001).
High TMAO levels are observed in patients with HF, and dose-dependently portend higher long-term mortality risk independent of BNP and renal function.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: New Paradigms in Prognostic Role of Biomarkers in Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1265-302
- 2013 American College of Cardiology Foundation