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.

Research Summary Information

  • 2015
  • Tang WH, Wang Z, Shrestha K, Borowski AG, Wu Y, Troughton RW, Klein AL, Hazen SL.
  • Center for Cardiovascular Diagnostics and Prevention, Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: tangw@ccf.org. Center for Cardiovascular Diagnostics and Prevention, Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland, Ohio. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Department of Mathematics, Cleveland State University, Cleveland, Ohio. Department of Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand. Center for Cardiovascular Diagnostics and Prevention, Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland, Ohio; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
  • Yes, Free full text of study was found:
  • Source of funding disclosure found
  • This research was supported by National Institutes of Health grants P01HL076491, P01HL103453, P01HL098055, R01HL103866 (with Office of Dietary Supplements), R01HL103931, P20HL113452 and the Cleveland Clinic Clinical Research Unit of the Case Western Reserve University CTSA (UL1TR 000439). The main ADEPT study was supported in part by grant funding from American Society of Echocardiography, GlaxoSmithKline Pharmaceuticals, and Roche Diagnostics Inc. Mass spectrometry studies were performed within a Mass Spectrometry Core facility that is supported in part by a Center of Innovation Award by AB SCIEX.
  • Potential conflicts disclosure found
  • Drs. Hazen and Wang report being listed as co-inventor on pending and issued patents held by the Cleveland Clinic relating to cardiovascular diagnostics and therapeutics. Dr. Hazen reports having been paid as a consultant or speaker for the following companies: Cleveland Heart Lab, Esperion, Lilly, Liposcience Inc., Merck & Co., Inc., Pfizer Inc., and Procter & Gamble. Dr. Hazen reports receiving research funds from Abbott, Cleveland Heart Lab, Liposcience Inc., Pfizer Inc., Procter & Gamble and Takeda Pharmaceuticals. Dr. Hazen reports having the right to receive royalty payments for inventions or discoveries related to cardiovascular diagnostics or therapeutics from the companies shown below: Cleveland Heart Lab., Esperion, Frantz Biomarkers, LLC, Liposcience Inc., and Siemens. Dr. Hazen is also partially supported by a gift from the Leonard Krieger endowment and by the Foundaton LeDucq. All other authors have no disclosures to report.
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