Association between plasma trimethylamine N-oxide level and atrial fibrillation

doi:10.16352/j.issn.1001-6325.2025.04.0499

Abstract

Abstract: Objective To explore the relationship between plasma trimethylamine N-oxide(TMAO) level and atrial fibrillation(AF) by a clinical trial. Methods Totally 257 patients with AF were enrolled including 114 patients with paroxysmal AF and 143 with persistent AF. The control group had 122 non-AF patients; Plasma TMAO level, the demographic characteristics and clinical data of patients were collected. Regression analysis was performed to identify the association between TMAO and presence of AF. Results Plasma TMAO level of patients with AF was higher than that of patients without AF(3.9[2.4-5.9]vs. 2.4[1.6-3.7]μmol/L,P＜0.001);Even after adjust-ment of confounding factors including age, hypertension, diabetes, heart failure and body mass index; Plasma TMAO level was still related to presence of AF(OR:1.290,95% CI:1.151-1.445;P＜0.001).The plasma TMAO level of patients with persistent AF was higher than that of patients with paroxysmal AF(4.4[2.8-6.8]vs. 3.2[2.2-5.0]μmol/L,P＜0.01); Even after adjustment of confounding factors including age, hypertension, diabetes and heart failure and coronary heart disease; Plasma TMAO level was still related to persistent AF(OR:1.092,95% CI:1.009-1.182;P=0.029). Conclusions The level of plasma TMAO of patients with AF is higher than that of patients without AF. Elevated plasma TMAO level is related to an increased risk of AF. Elevated plasma TMAO level in patients with AF is related to an increased risk of persistent AF.

Key words: trimethylamine N-oxide, atrial fibrillation, paroxysmal atrial fibrillation, persistent atrial fibrillation

CLC Number:

R541.7

YANG Wentao, ZHAO Qing, LI Xiangdong, WANG Yutang, LIU Wei. Association between plasma trimethylamine N-oxide level and atrial fibrillation[J]. Basic & Clinical Medicine, 2025, 45(4): 499-504.

References

[1] Kornej J, Borschel CS, Benjamin EJ, et al. Epidemiology of atrial fibrillation in the 21st century: novel methods and new insights[J]. Circ Res, 2020,127:4-20.
[2] Tang W, Li DY, Hazen SL. Dietary metabolism, the gut microbiome, and heart failure[J]. Nat Rev Cardiol, 2019,16:137-154.
[3] Witkowski M, Weeks TL, Hazen SL. Gut microbiota and cardiovascular disease[J]. Circ Res, 2020,127:553-570.
[4] Luqman A, Hassan A, Ullah M, et al. Role of the intestinal microbiome and its therapeutic intervention in cardiovascular disorder[J]. Front Immunol, 2024,15:1321395.doi: 10.3389/fimmu.2024.1321395.
[5] Gawalko M, Agbaedeng TA, Saljic A, et al. Gut microbiota, dysbiosis and atrial fibrillation. arrhythmogenic mechanisms and potential clinical implications[J].Cardiovasc Res, 2022,118:2415-2427.
[6] Linz D, Gawalko M, Sanders P, et al. Does gut microbiota affect atrial rhythm? causalities and specula-tions[J]. Eur Heart J, 2021,42:3521-3525.
[7] Svingen G, Zuo H, Ueland PM, et al. Increased plasma trimethylamine-N-oxide is associated with incident atrial fibrillation[J]. Int J Cardiol, 2018,267:100-106.
[8] Papandreou C, Bullo M, Hernandez-Alonso P, et al. Choline metabolism and risk of atrial fibrillation and heart failure in the PREDIMED Study[J]. Clin Chem, 2021,67:288-297.
[9] Nguyen BO, Meems L, van Faassen M, et al. Gut-microbe derived TMAO and its association with more progressed forms of AF: results from the AF-RISK study[J]. Int J Cardiol Heart Vasc, 2021,34:100798.doi: 10.1016/j.ijcha.2021.100798.
[10] Buttner P, Okun JG, Hauke J, et al. Trimethylamine N-oxide in atrial fibrillation progression[J]. Int J Cardiol Heart Vasc, 2020,29:100554.doi:10.1016/j.ijcha.2020.100554.
[11] Guo Y, Wang Y, Li X, et al. Optimal thromboprophylaxis in elderly Chinese patients with atrial fibrillation(ChiOTEAF) registry: protocol for a prospective, observational nationwide cohort study[J]. BMJ Open, 2018,8:e20191.doi: 10.1136/bmjopen-2017-020191.
[12] Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery(EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology(ESC) developed with the special contribution of the European Heart Rhythm Association(EHRA) of the ESC[J]. Eur Heart J, 2021,42:373-498.
[13] Peduzzi P, Concato J, Kemper E, et al. A simulation study of the number of events per variable in logistic regression analysis[J]. J Clin Epidemiol, 1996,49:1373-1379.
[14] Pelletier CC, Croyal M, Ene L, et al. Elevation of trimethylamine-N-oxide in chronic kidney disease: contribution of decreased glomerular filtration rate[J]. Toxins(Basel), 2019,11:635. doi: 10.3390/toxins11110635.
[15] Gawalko M, Jespersen T, Dobrev D, et al. The gut microbial-derived metabolite trimethylamine N-oxide: a missing link between lifestyle-components and atrial fibrillation?[J]. Int J Cardiol Heart Vasc, 2020,29:100581. doi: 10.3390/toxins11110635.