TMAO前体有望预测急性冠状动脉综合征预后
  • 包含530名疑似急性冠状动脉综合征(ACS)患者的研究中,三甲基赖氨酸(TML) 与患者在30天和6个月内的主要不良心脏事件(MACE)有关;
  • TML与不良预后的关系,与传统心血管疾病风险及肾功能无关;
  • TML的升高与7年内全因死亡风险有关,与就诊时心肌肌钙蛋白T检测阴性患者的MACE也有关;
  • 在另一项纳入1683人的研究中,TML与1年内心血管疾病风险增加的联系得到证实;
  • TML与TMAO对于预测近期、长期的心血管风险事件具有重要价值。
主编推荐语
小肠君
心血管疾病标志物TMAO的前体物质TML与心血管疾病风险相关。《European Heart Journal》近期发表研究,纳入两个人群研究,发现TML与急性冠状动脉综合征患者短期、长期预后情况具有相关,TML可能是心血管疾病的标志物。该结果对于心血管疾病的诊断以及预后预测具有重要参考价值。
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Trimethyllysine, a trimethylamine N-oxide precursor, provides near- and long-term prognostic value in patients presenting with acute coronary syndromes

TMAO前体三甲基赖氨酸在具有预测急性冠状动脉综合征患者短期、长期预后的价值

10.1093/eurheartj/ehz259

2019-04-25, Article

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Aims: Trimethyllysine (TML) serves as a nutrient precursor of the gut microbiota-derived metabolite trimethylamine Noxide (TMAO) and is associated with incident cardiovascular (CV) events in stable subjects. We examined the relationship between plasma TML levels and incident CV events in patients presenting with acute coronary syndromes (ACS).
Methods and results: Plasma levels of TML were quantified in two independent cohorts using mass spectrometry, and its relationship with CV events was investigated. In a Cleveland Cohort (N= 530), comprised of patients presenting to the emergency department with chest pain and suspected ACS, TML was associated with major adverse cardiac events (MACE, myocardial infarction, stroke, need for revascularization, or all-cause mortality) over both 30 days [3rd tertile (T3), adjusted odds ratio (OR) 1.77, 95% confidence interval (CI) 1.04–3.01; P < 0.05] and 6 months (T3, adjusted OR 1.95, 95% CI 1.15–3.32; P < 0.05) of follow-up independent of traditional CV risk factors and indices of renal function. Elevated TML levels were also associated with incident long-term (7-year) all-cause mortality [T3, adjusted hazard ratio (HR) 2.52, 95% CI 1.50–4.24; P < 0.001], and MACE even amongst patients persistently negative for cardiac Troponin T at presentation (e.g. 30-day MACE, T3, adjusted OR 4.49, 95% CI 2.06–9.79; P < 0.001). Trimethyllysine in combination with TMAO showed additive significance for near- and long-term CV events, including patients with ‘negative’ high-sensitivity Troponin T levels. In a multicentre Swiss Cohort (N= 1683) comprised of ACS patients, similar associations between TML and incident 1-year adverse cardiac risks were observed (e.g. mortality, adjusted T3 HR 2.74, 95% CI 1.28–5.85; P < 0.05; and MACE, adjusted T3 HR 1.55, 95% CI 1.04–2.31;P < 0.05).
Conclusion: Plasma TML levels, alone and together with TMAO, are associated with both near- and long-term CV events in patients with chest pain and ACS.

First Authors:
Xinmin S Li,Slayman Obeid

Correspondence Authors:
Stanley L Hazen

All Authors:
Xinmin S Li,Slayman Obeid,Zeneng Wang,Benjamin J Hazen,Lin Li,YupingWu,Alex G Hurd,Xiaodong Gu,Alan Pratt,Bruce S Levison,YoonMi Chung,Steven E Nissen,Wai Hong Wilson Tang,Francois Mach,Lorenz Raber,David Nanchen,Christian M Matter,Thomas F Luscher,Stanley L Hazen

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