Association of gut-related metabolites with outcome in acute heart failure

Trimethylamine N-oxide (TMAO), a gut-related metabolite, is associated with heart failure (HF) outcomes. However, TMAO the final product of complex metabolic pathway (ie, choline/carnitine) that has never been entirely investigated in HF. The present study investigates panel metabolites involved TMAO-choline/carnitine for their associations outcome acute HF patients. In total, 806 plasma samples from patients were analyzed TMAO, trimethyllysine, L-carnitine, acetyl-L-carnitine, γ-butyrobetaine, crotonobetaine, trimethylamine, betaine aldehyde, choline, and using developed liquid chromatography-tandem mass spectrometry method. Associations all-cause mortality (death) composite and/or rehospitalization caused by (death/HF) at 30 days 1 year investigated. γ-butyrobetaine death death/HF (short term; hazard ratio 1.30-1.49, P≤ .021) (long 1.15-1.25, .026) when adjusted cardiac risk factors. L-carnitine acetyl-L-carnitine superior short-term outcomes whereas was metabolite association long-term Furthermore, in-hospital improved stratification combined current clinical scores Acute Decompensated HEart Failure National REgistry, Organized Program To Initiate Lifesaving Treatment Hospitalized Patients With Heart Failure, Get Guidelines-Heart Failure; odds (OR) ≥ 1.52, .020). Carnitine-related show adverse HF, particular outcomes, Further studies are warranted to investigate role implications carnitine including intervention pathogenesis