Plasma Trimethylamine N-oxide Levels And Prognosis In Patients With Acute Heart Failure

Objective Acute heart failure(AHF)is associated with high mortality and morbidity.The present study investigated plasma TMAO levels in patients with AHF that admitted in the first affiliated hospital of University of South China,and have a preliminary analysis of the relationships between TMAO levels with patients' vital signs and clinical biochemical indicators.To analyze TMAO levels in patients with different clinical outcomes and preliminarily discuss the value of poor prognosis prediction compared with NT-pro BNP and TMAO in AHF patients.Methods 64 plasma samples were analyzed for TMAO concentration by LC-MS/MS.Record the patients' medical history,vital signs,routine blood,liver and kidney function,NT-pro BNP,CRP,albumin,cholinesterase,left heart ejection fraction,lactate,and treatment;and followed up the group of patients after an average of a year.SPSS 24.0 and Graph Pad Prism 8.0.1 are used to analyze the relationship between plasma TMAO levels and these relevant indicators by t-test,Pearson test,logistic regression analysis,Kaplan-Meier's survival analysis and receiver operating characteristic.To preliminarily analysis the relationship between plasma TMAO levels and patients' general condition,clinical biochemical indicators,treatment,disease severity and poor prognosis,and to study whether TMAO can be an effective independent risk factor for predicting death.Result 1.This study chose 64 patients with acute heart failure to investigate.After 6months to 1 year followed up,there were finally 58 patients in this study and 28 patients died of heart failure(48.28%),and 6 cases lost follow-up.The men was accounted for 67.24%(n=39),aged from 35-93 years,with an average age of(69.53±13.52)years.2.The median TMAO level was 2.58umol/L.There was significant correlation between TMAO concentrations and NT-pro BNP,creatinine,urea nitrogen,potassium levels(P<0.05).There were significant differences in TMAO levels between whether the patient had COPD,and it also has a significant difference between the group with myocardial injury due to acute myocardial infarction and the group with myocardial injury due to other causes(P<0.05),between the group with heart failure due to infection and the group with heart failure due to other factors(P<0.05),between the group with heart failure caused by pulmonary heart disease and the group with heart failure caused by other heart diseases(P<0.05).3.Survival was estimated using the Kaplan-Meier method.The average total survival time of the TMAO?2.58umol/L group was 172.50days[95%CI(101.57-243.43)],which TMAO<2.58umol/L group was 281.71 days[95%CI(213.29-350.14)].The log-rank(Mantel-cox)test was used to check the result: ?2(TMAO?2.58umol/L v.s.TMAO<2.58umol/L)= 4.056,(P<0.05).4.The AHF patients were divided into the death group and the survival group.There was a significant difference in TMAO level between the survival group and the death group.The plasma TMAO level of the death group was significantly higher than that of the survival group(P<0.05).5.The ROC curve was used to analyze the value of plasma TMAO levels and NT-pro BNP levels of predicting the death of AHF patients within 1 year.The best prediction concentration of TMAO was 5.3umol/L,with a sensitivity of 57.1% and a specificity of 6.7%.The best prediction concentration of NT-pro BNP was 5.3umol/L,with a sensitivity of 60.7% and a specificity of 13.3%.6.Prognosis was set as the dependent variable(survival=0,death=1),Logistic analysis showed that the correlation between TMAO and NT-pro BNP with the poor prognosis in AHF patients were significant(P<0.05).The probability of death with one more unit of plasma TMAO(1nmol/L)was 1.043 times higher than that with one unit of plasma TMAO lower.And with one more unit of plasma NT-pro BNP(1000ng/L)was 1.027 times higher than the lower.TMAO level could still significantly affect the death of AHF patients(P<0.05)when consider renal function.Meanwhile,NT-pro BNP can also effect the death of AHF patients(P<0.05)under the same conditions.Conclusions 1.Compared with the plasma TMAO level in the survival group,the death group has higher plasma TMAO level.2.Plasma TMAO level has a certain value in predicting the death of AHF patients within 1 year,but the advantages and disadvantages between its and NT-pro BNP still need to further study.3.Plasma TMAO level can be a risk factor which is independent of renal function.