Gut microbiota-dependent metabolite trimethylamine N-oxide (TMAO) and cardiovascular risk in patients with suspected functionally relevant coronary artery disease (fCAD)

• DOI: 10.1007/s00392-022-01992-6
• Publication Date: 2022-02-26T19:02:27Z
• Authors: Melissa Amrein; Xinmin S. Li; Joan Walter; Zeneng Wang; Tobias Zimmermann; Ivo Strebel; Ursina Honegger; Kathrin Leu; Ibrahim Schäfer; Raphael Twerenbold; Christian Puelacher; Noemi Glarner; Thomas Nestelberger; Luca Koechlin; Benjamin Ceresa; Philip Haaf; Adam Bakula; Michael Zellweger; Stanley L. Hazen; Christian Mueller
• Keywords: Trimethylamine N-oxide; Choline; Betaine; Acetylcarnitine

Trimethylamine N-oxide (TMAO) has been associated with cardiovascular outcomes. However, the diagnostic value of TMAO and its precursors have not assessed for functionally relevant coronary artery disease (fCAD) prognostic potential in this setting needs to be evaluated.Among 1726 patients suspected fCAD serum TMAO, betaine, choline carnitine, were quantified using liquid chromatography tandem mass spectrometry. Diagnosis was performed by myocardial perfusion single photon emission tomography (MPI-SPECT) angiography blinded marker concentrations. Incident all-cause death, death (CVD) infarction (MI) during 5-years follow-up.Concentrations carnitine significantly higher versus those without (TMAO 5.33 μM vs 4.66 μM, p < 0.001); however, accuracy low area under receiver operating curve [AUC]: 0.56, 95% CI [0.53-0.59], 0.001). In analyses, above median (p 0.001 all) cumulative events CVD follow-up. remained a significant predictor even full models adjusted renal function (HR = 1.58 (1.16, 2.14), 0.003; HR 1.66 [1.07, 2.59], 0.025). Prognostic discriminative good robust (2-years AUC 0.73, [0.65-0.80]).TMAO precursors, fCAD, but limited value. strong incident fCAD.NCT01838148.