Gut-microbe derived TMAO and its association with more progressed forms of AF: Results from the AF-RISK study

B O Nguyen, L M G Meems, M van Faassen, H J G M Crijns, I C van Gelder, F Kuipers, M Rienstra, B O Nguyen, L M G Meems, M van Faassen, H J G M Crijns, I C van Gelder, F Kuipers, M Rienstra

Abstract

Introduction: The importance of gut microbiome in cardiovascular disease has been increasingly recognized. Trimethylamine N-oxide (TMAO) is a gut microbe-derived metabolite that is associated with cardiovascular disease, including atrial fibrillation (AF). The role of TMAO in clinical AF progression however remains unknown.

Methods and results: In this study we measured TMAO and its precursor (betaine, choline, and L- carnitine) levels in 78 patients using plasma samples from patients that participated in the AF-RISK study. 56 patients suffered from paroxysmal AF and 22 had a short history of persistent AF. TMAO levels were significantly higher in patients with persistent AF, as compared to those with paroxysmal AF (median [IQR] 5.65 [4.7-9.6] m/z versus 4.31 [3.2-6.2] m/z, p < 0.05), while precursor levels did not differ. In univariate analysis, we observed that for every unit increase in TMAO, the odds for having persistent AF increased with 0.44 [0.14-0.73], p < 0.01. Conclusion: These results suggest that higher levels of TMAO are associated with more progressed forms of AF. We therefore hypothesize that increased TMAO levels may reflect disease progression in humans. Larger studies are required to validate these preliminary findings.Trial Registration number: Clinicaltrials.gov NCT01510210.

Keywords: AF progression; Atrial fibrillation; Gut microbiome; TMAO.

Conflict of interest statement

The authors report no relationships that could be construed as a conflict of interest.

© 2021 The Author(s).

Figures

Fig. 1
Fig. 1
Schematic overview of AF burden in patients from AF-RISK with baseline characteristics of all participants including plasma TMAO levels (m/z), plasma betaine levels (m/z), plasma choline levels (m/z) and plasma L- carnitine levels (m/z), including an overview of the association between AF progression and the association with plasma TMAO levels (m/z). BMI = body mass index; IQR = interquartile range; eGFR = estimated glomerular filtration rate (mL/min/1.73 m2); CAD = coronary artery disease; HC = hypercholesterolemia; DM II = diabetes mellitus type II; TMAO = Trimethylamine N-oxide.
Fig. 2
Fig. 2
Statin use (percentage) and the effect on plasma TMAO levels per tertile.

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Source: PubMed

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