Plasma Trimethylamine N-Oxide as a Novel Biomarker for Plaque Rupture in Patients With ST-Segment–Elevation Myocardial Infarction

Abstract

Background: Trimethylamine N-oxide (TMAO) is reported to promote the pathogenesis of atherosclerosis and be associated with cardiovascular events risk. It is unknown whether plasma TMAO is associated with plaque morphology in patients with acute myocardial infarction. We investigated the relationship between the culprit plaque morphology and plasma TMAO concentration in patients with ST-segment–elevation myocardial infarction. Methods and Results: A prospective series of 211 patients with ST-segment–elevation myocardial infarction who underwent preintervention optical coherence tomography examination for the culprit lesion were enrolled; 77 and 69 patients were categorized as plaque rupture and plaque erosion, respectively. Plasma TMAO levels, detected using stable isotope dilution liquid chromatography tandem mass spectrometry, were significantly higher in patients with plaque rupture than in those with plaque erosion (3.33 μM; interquartile range: 2.48–4.57 versus 1.21 μM; interquartile range: 0.86–1.91; P <0.001). After adjustments for traditional risk factors, elevated TMAO levels remained independently correlated with plaque rupture (adjusted odds ratio: 4.06, 95% CI, 2.38–6.91; P <0.001). The area under the receiver operating characteristic curve for plaque rupture versus plaque erosion was 0.89. At a cutoff level of 1.95 μM, TMAO had a sensitivity of 88.3% and specificity of 76.8% in discriminating plaque rupture from plaque erosion. Conclusions: High levels of plasma TMAO independently correlated with plaque rupture in patients with ST-segment–elevation myocardial infarction. Moreover, TMAO might be a useful biomarker for plaque rupture to improve risk stratification and management in patients with ST-segment–elevation myocardial infarction. Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT03593928.

Association of trimethylamine N-oxide with coronary atherosclerotic burden in patients with non-ST-segment elevation myocardial infarction

“…[ 15 ] Another prospective series of 211 patients with STEMI demonstrated higher TMAO levels association with plaque rupture assessed by optical coherence tomography examination and these findings have significant adverse risks in CVD patients. [ 22 ] The association of TMAO with atherosclerosis burden in stable coronary artery disease has also been reported previously. [ 21 ] In light of these promising findings, the evaluation TMAO and TML are warranted in NSTEMI patients as represent the most frequent group of CVD patients undergoing pPCI, which may serve as a potential target for atherosclerosis prevention and treatment as compared with present traditional treatments.…”

Gut Microbiota and Ischemic Stroke: The Role of Trimethylamine N-Oxide

“…Plasma TMAO concentrations were significantly higher in patients with ST-segment elevation myocardial infarction with plaque rupture than in patients exhibiting plaque erosion. The authors suggested that TMAO could be a useful biomarker for predicting plaque rupture in patients with a history of acute myocardial infarction [26].…”

TMAO: how gut microbiota contributes to heart failure

“…10 Recently, TMAO has emerged as a significant mediator, demonstrating a close relationship between gut microbiota and multiple CVDs such as atherosclerosis, hypertension, diabetes, and myocardial infarction. [11][12][13][14][15] Remarkably, TMAO is also a powerful prognostic marker, participating in the progression of HF. 16 Subsequent preclinical experiments show that TMAO may directly affect the heart by inducing myocardial hypertrophy and fibrosis, endothelial cell and vascular inflammation, as well as cardiac mitochondrial dysfunction, thereby aggravating the progress of HF.…”