Intestinal microbiota-dependent phosphatidylcholine metabolites, diastolic dysfunction, and adverse clinical outcomes in chronic systolic heart failure.

Increased dietary exposure to choline, betaine, and trimethylamine-N-oxide (TMAO) predisposes cardiovascular disease patients to adverse cardiac events, such heart failure.

Choline, betaine, and phosphatidylchomine are dietary precursors of trimethylamine-N-oxide (TMAO). This study examined the relationship between the circulating levels of the choline, betaine, and trimethylamine-N-oxide (TMAO) and the incidence of heart failure and other adverse cardiac events. Researchers analyzed the concentrations of TMAO, betaine, and choline in the blood of 112 chronic systolic heart failure patients. The echocardiography values of all the patients were also assessed.

Researchers found elevated plasma levels of choline, betaine, TMAO, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in diabetic patients and subjects with New York Heart Association Functional III. A greater incidence of advanced left ventricular diastolic dysfunction and adverse cardiac events were observed in subjects with high serum concentrations of TMAO, choline, and betaine. Circulating level of TMAO in the blood was found to be a good predictor of the occurrence of adverse cardiovascular events in this study. The findings of this study support the hypothesis that high TMAO plasma content may increase cardiovascular risk and the prevalence of adverse cardiac events, such as heart failure.