Trimethylamine N-Oxide Was Not Associated With 30-Day Left Ventricular Systolic Dysfunction in Patients With a First Anterior ST-Segment Elevation Myocardial Infarction After Primary Revascularization: A Sub-analysis From an Optical Coherence Tomography Registry

Abstract

Objective: Left ventricular systolic dysfunction (LVSD) after ST-segment elevation myocardial infarction (STEMI) is associated with poor outcome. Trimethylamine N-oxide (TMAO), a gut metabolite, is linked to cardiovascular diseases but its relationship with LVSD after STEMI remains unclear. The present study therefore aimed to investigate the relationship between TMAO and LVSD at 30 days after a first anterior STEMI. Methods: This was a sub-study from the OCTAMI (Optical Coherence Tomography Examination in Acute Myocardial Infarction) registry. Eligible patients were included in current study if they: (1) presented with a first anterior STEMI; (2) had available baseline TMAO concentration; (3) completed a cardiovascular magnetic resonance examination at 30 days after STEMI. LVSD was defined as left ventricular ejection fraction < 50%. Associations between TMAO and left ventricular ejection fraction, infarct size and left ventricular global strain were examined. Results: In total, 78 patients were included in final analysis. Overall, TMAO was moderately associated with peak cTnI (r = 0.27, p = 0.01), age (r = 0.34, p < 0.01), and estimated glomerular filtration rate (r = -0.30, p < 0.01). At 30-day follow-up, 41 patients were in the LVSD group and 37 in the non-LVSD group. Baseline TMAO levels were not significantly different between the two groups (LVSD vs. non-LVSD: median 1.9 μM, 25-75th percentiles 1.5-3.3 μM vs. median 1.9 μM, 25-75th percentiles 1.5-2.7 μM; p = 0.46). Linear regression analyses showed that TMAO was not associated with left ventricular ejection fraction, infarct size or left ventricular global strain at 30 days (all p > 0.05). Conclusions: TMAO was not significantly correlated with 30-day LVSD in patients with a first anterior STEMI after primary revascularization. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT03593928.

Keywords: ST-segment elevation myocardial infarction; cardiovascular magnetic resonance; gut metabolite; left ventricular systolic dysfunction; trimethylamine N-oxide.

Figure 1

Study flow. CMR indicates cardiovascular magnetic resonance; LVEF, left ventricular ejection fraction; LVSD, left ventricular systolic dysfunction; OCTAMI registry, Optical Coherence Tomography Examination in Acute Myocardial Infarction registry (NCT03593928); STEMI, ST-segment elevation myocardial infarction; TMAO, trimethylamine-N-oxide.

Figure 2

Pearson correlations between TMAO and traditional biomarkers, including peak cTnI (A) and peak NT-proBNP (B). cTnI indicates cardiac troponin I; NT-proBNP, N-terminal pro B-type Natriuretic Peptide; TMAO, trimethylamine-N-oxide.

Figure 3

TMAO levels grouped by LVSD at baseline (A), at 30-day follow-up (B) and both (C). In (C), groups are defined as follows: Group a includes patients not presenting LVSD at both baseline and 30 days; Group b includes patients presenting with LVSD solely at 30 days; Group c includes patients presenting with LVSD solely at baseline; Group d includes patients presenting persistent LVSD at both baseline and 30-days. LVEF indicates left ventricular ejection fraction; LVSD, left ventricular systolic dysfunction; TMAO, trimethylamine-N-oxide.