Trimethylamine N-oxide and outcomes in patients hospitalized with acute heart failure and preserved ejection fraction.
Trimethylamine N-oxide and outcomes in patients hospitalized with acute heart failure and preserved ejection fraction.
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急性心力衰竭和射血分数保留住院患者的N-氧化三甲胺和预后
DOI：
10.1002/ehf2.13290
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发表时间：
2021-06
影响因子：
3.8
通讯作者：
Yamamoto K
中科院分区：
文献类型：
--
作者：
Kinugasa Y;Nakamura K;Kamitani H;Hirai M;Yanagihara K;Kato M;Yamamoto K
氧化三甲胺（TMAO）是一种来自肠道微生物群的代谢物。TMAO水平升高与射血分数降低的心力衰竭患者预后不良相关。然而，TMAO水平升高对射血分数保留性心力衰竭（HFpEF）的预后影响尚不清楚。我们连续入组了146例从鸟取大学医院住院和出院的患者，主要诊断为HFpEF（射血分数≥ 50%）。高TMAO水平被定义为高于患者中位值（20.37 μmol/L）。与TMAO水平低的患者相比，TMAO水平高的患者因心力衰竭和严重肾功能不全而住院的患病率显著较高。他们也有一个显着较高的酰基肉碱游离肉碱比那些低TMAO水平，这表明脂肪酸代谢异常和相对肉碱缺乏。在多变量分析中对患者背景差异进行调整后，高TMAO水平仍然与心脏原因死亡和心力衰竭住院的复合终点的高发生率独立相关（调整后的风险比为1.91; 95%置信区间为1.01至3.62; P < 0.05）。TMAO和营养状况对主要结局有显著的相互作用，营养不良患者TMAO的预后作用增强。出院时TMAO水平升高与HFpEF患者出院后心脏事件风险增加相关，尤其是那些伴有营养不良并发症的患者。
Trimethylamine N‐oxide (TMAO) is a metabolite derived from the gut microbiota. Elevated TMAO levels are associated with a poor prognosis in patients with heart failure with reduced ejection fraction. However, the prognostic effect of elevated TMAO levels on heart failure with preserved ejection fraction (HFpEF) remains unclear. We consecutively enrolled 146 patients who were hospitalized and discharged from Tottori University Hospital with the primary diagnosis of HFpEF (ejection fraction ≥ 50%). High TMAO levels were defined as those greater than the median value in the patients (20.37 μmol/L). Patients with high TMAO levels had a significantly higher prevalence of prior hospitalization for heart failure and severe renal dysfunction than those with low TMAO levels. They also had a significantly higher acylcarnitine to free carnitine ratio than those with low TMAO levels, which indicated abnormal fatty acid metabolism and relative carnitine deficiency. After adjustment for differences in the patients' background in multivariate analysis, high TMAO levels remained independently associated with a high incidence of the composite endpoints of death due to cardiac causes and hospitalization for heart failure (adjusted hazard ratio, 1.91; 95% confidence interval, 1.01 to 3.62; P < 0.05). There was a significant interaction between TMAO and nutritional status on the primary outcome, and the prognostic effect of TMAO was enhanced in patients with malnutrition. Elevated TMAO levels at discharge are associated with an increased risk of post‐discharge cardiac events in patients with HFpEF, especially those with the complication of malnutrition.
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影响因子：
3.8
作者：
Kinugasa Y;Nakamura K;Kamitani H;Hirai M;Yanagihara K;Kato M;Yamamoto K
通讯作者：
Yamamoto K
影响因子：
6.2
作者：
Lang, Roberto M.;Badano, Luigi P.;Voigt, Jens-Uwe
通讯作者：
Voigt, Jens-Uwe
影响因子：
5.7
作者：
Suzuki, Toru;Heaney, Liam M.;Ng, Leong L.
通讯作者：
Ng, Leong L.
影响因子：
3.5
作者：
Makrecka-Kuka, Marina;Volska, Kristine;Dambrova, Maija
通讯作者：
Dambrova, Maija
DOI：
10.1161/circinterventions.118.007281
发表时间：
2019-01-01
影响因子：
5.6
作者：
Tan, Yu;Sheng, Zhaoxue;Yan, Hongbing
通讯作者：
Yan, Hongbing