Microbiota thrombus colonization may influence athero-thrombosis in hyperglycemic patients with ST segment elevation myocardialinfarction (STEMI). Marianella study

Abstract

Objectives. We examined the association of the coronary thrombus microbiota and relative metabolites with major adverse cardiovascular events (MACE) in hyperglycemic patients with ST segment elevation myocardial infarction (STEMI).Background. Hyperglycemia during STEMI may affect both development and progression of coronary thrombus via gut and thrombus microbiota modi cations.Methods. We undertook an observational cohort study of 146 rst STEMI patients treated with primary percutaneous coronary intervention (PPCI) and thrombus-aspiration (TA). Patients were clustered, based on admission blood glucose levels, in hyperglycemic (>140 mg/dl) and normoglycemic (<140 mg/dl). We analyzed gut and thrombus microbiota in all patients. Moreover, we assessed TMAO, CD40L and von Willebrand Factor (vWF) in coronary thrombi. Cox regressions were used for the association between Prevotellaspp and TMAO terziles and MACE. MACE endpoint at 1 year included death, re-infarction, unstable angina.Results. In fecal and thrombus samples, we observed a signi cantly different prevalence of both Prevotellaspp and Alistipesspp. between patients with hyperglycemia (n=56) and those with normal glucose levels (n=90). The abundance of Prevotella increased in hyperglycemic vs normoglycemic patients whereas the contrary was observed for Alistipes. Interestingly, in coronary thrombus, the content of Prevotella was associated with admission blood glucose levels (p<0.01), thrombus dimensions (p<0.01), TMAO, CDL40 (p<0.01) and vWF (p<0.01) coronary thrombus contents. Multivariate Coxanalysis disclosed a reduced survival in patients with high levels of Prevotella and TMAO in coronary thrombus as compared to patients with low levels of Prevotella and TMAO, after 1-year follow up.Conclusions. Hyperglycemia during STEMI may increase coronary thrombus burden via gut and thrombus microbiota dysbiosis characterized by an increase of Prevotella and TMAO content in thrombi.

Prognostic value of stress hyperglycemia ratio on short- and long-term mortality after acute myocardial infarction

“…There are several eligible pathophysiological mechanisms potentially mediating a causal relationship. On the one hand, hyperglycemia during the AMI is supposed to be a main determinant of atherosclerotic plaque instability and rupture [ 5 ] and furthermore affects coronary thrombus composition [ 6 ] and increase coronary thrombus burden via thrombus microbiota dysbiosis [ 26 ]. On the other hand, hyperglycemia might exhibit sympathetic over-activity with a hyperglycemia-mediated proinflammatory pathway and in this affecting outcome [ 27 ].…”

Essential Fatty Acids as Biomedicines in Cardiac Health

“…To relate these effects more closely to our study, the TMAO levels are also influenced by the diet and by the secondary effects on the microbiome [37]; however, little effect was observed on the TMAO levels [38]. On this note, it has only recently been shown that higher contents of Prevotella in hyperglycemic coronary are associated with high thrombus burden and TMAO in hyperglycemic patients [39].…”

Qiliqiangxin Modulates the Gut Microbiota and NLRP3 Inflammasome to Protect Against Ventricular Remodeling in Heart Failure

“…The relative abundance changes of Prevotella were reported to injure the colonic epithelia, resulting in inflammation and thus inflammatory cytokine generation like IL-6, TNF-a, and IL-8 ( Xia et al, 2021 ). It is also related to TMAO production ( Sardu et al, 2021 ). Oscillibacter ( Chen et al, 2020 ; Dessì et al, 2021 ), Roseburia ( Cornuault et al, 2020 ), Bacteroides ( Yuan et al, 2021 ), Paraprevotella ( Fei et al, 2019 ; Zhang X. et al, 2021 ), Phascolarctobacterium ( Pan et al, 2021 ), and Intestinimonas ( Afouda et al, 2019 ; Luo et al, 2021 ) exert promoting effects in the SCFA generation or associate positively with its content.…”