Plasma trimethylamine n-oxide is associated with renal function in patients with heart failure with preserved ejection fraction

Fei Guo,Xueting Qiu,Zhirong Tan,Dongsheng Ouyang,Zhenyu Li

doi:10.1186/s12872-020-01669-w

Abstract

BackgroundHeart failure with preserved ejection fraction (HFpEF) is an emerging global health problem with less awareness. Renal dysfunction in HFpEF is associated with worse outcome. However, there is lack of rapid, noninvasive and accurate method for risk stratification in HFpEF and renal dysfunction. This study aimed to explore the utility of plasma trimethylamine n-oxide (TMAO) for evaluation of HFpEF and renal function.MethodsPlasma TMAO levels were measured in total 324 subjects comprising 228 HFpEF patients and 96 healthy controls.ResultsTMAO levels were significantly elevated in patients with HFpEF compared with controls (12.65(9.32–18.66) μg/l vs 10.85(6.35–15.58) μg/l, p < 0.01). Subjects in higher TMAO tertile group had more incidences of HFpEF ((78.5%) in tertile 3 vs (73.39%) in tertile 2 vs (59.26%) in tertile 1, p < 0.01). TMAO concentrations were inversely correlated with estimated glomerular filtration rate (eGFR) and HFpEF patients with impaired renal function (eGFR < 60 ml/min/1.73 m2) had higher TMAO than those with normal eGFR (≥ 60 ml/min/1.73 m2) (14.18(10.4–23.06) μg/l vs 10.9(7.48–15.47) μg/l, p < 0.01). Increased TMAO levels were independently associated with higher risk of HFpEF (OR = 3.49, 95% CI: 1.23–9.86, p = 0.02) and renal dysfunction (OR = 9.57, 95% CI: 2.11–43.34, p < 0.01) after adjustment for multiple traditional risk factors. Furthermore, TMAO had good performance at distinguishing HFpEF from controls (AUC = 0.63, p < 0.01), and renal dysfunction from normal renal function in HFpEF (AUC = 0.67, p < 0.01).ConclusionIn this cross-sectional study, HFpEF and renal function were closely related with plasma TMAO levels and TMAO may serve as a diagnostic biomarker for HFpEF and renal function.

Highlights

Heart failure with preserved ejection fraction (HFpEF) is an emerging global health problem with less awareness
We aimed to explored the relationship between plasma trimethylamine n-oxide (TMAO) levels with HFpEF and renal dysfunction, defined as estimated glomerular filtration rate < 60 ml/min/1.73 m2, in a hospital-based southern Chinese cohort
Patients characteristics Of the 228 HFpEF patients and 96 healthy controls, the baseline patient characteristics are displayed in Table 1 as categorized by HFpEF and CON group

Summary

Introduction

Heart failure with preserved ejection fraction (HFpEF) is an emerging global health problem with less awareness. Renal dysfunction in HFpEF is associated with worse outcome. There is lack of rapid, noninvasive and accurate method for risk stratification in HFpEF and renal dysfunction. Heart failure with preserved ejection fraction (HFpEF) is a diverse syndrome marked by myocyte hypertrophy, concentric left ventricular remodeling, and end-diastolic stiffness. Patients with HFpEF have clinical features of heart failure but exhibit normal or near-normal left ventricular ejection fraction (EF), usually 50% or above. A major drawback regarding the development of new therapies for HFpEF, is the absence of clear diagnostic criteria, which bring difficulties to the definition of patients in clinical diagnosis. The diagnosis of HFpEF is solely based echocardiography, which is somehow low in resolution, and the results are susceptible to physicians’ clinical skills

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