High levels of Trimethylamine-N-oxide increase risk of cerebral infarction and mortality in AF patients

The key findings of this study were:

1. In comparison to patients in the lowest tertile, subjects in the highest TMAO tertile were older, had worse renal function, were more likely to have diabetes, and had a greater prevalence of heart failure. 89.1%, 94.0%, and 88.2% of individuals, respectively, used oral anticoagulants (from high to low tertiles).

2. When baseline variables were taken into account, Cox models revealed higher overall mortality and cardiovascular mortality in the highest tertile compared to the lowest tertile.

3. On MRI, participants in the highest tertile were more likely to have tiny non-cortical infarcts and more likely to have copious, massive, non-cortical and cortical infarcts (log-transformed volumes; exponentiated estimate 1.89, 95% CI 1.11 to 3.21, p=0.02).

Reference:

Luciani, M., Müller, D., Vanetta, C., Diteepeng, T., von Eckardstein, A., Aeschbacher, S., Rodondi, N., Moschovitis, G., Reichlin, T., Sinnecker, T., Wuerfel, J., Coslovsky, M., Camici, G. G., Lüscher, T. F., Kuehne, M., Osswald, S., … Beer, J. H. (2023). Trimethylamine-N-oxide is associated with cardiovascular mortality and vascular brain lesions in patients with atrial fibrillation. In Heart. BMJ. https://doi.org/10.1136/heartjnl-2022-321300