Clinical study of TMAO and heart failure with reduced ejection fraction combined with type 2 diabetes mellitus

Yang Zhenxing; Wu Xue; Cheng Hua; Wang Qiaoling

doi:10.3969/j.issn.1674-4055.2025.09.17

Abstract：Objective To investigate the serum levels and predictive value of trimethylamine N-oxide(TMAO)in patients with heart failure with reduced ejection fraction(HFrEF)complicated by type 2 diabetes mellitus(T2DM).Methods A total of 156 hospitalized HFrEF patients admitted to the General Hospital of Ningxia Medical University from October 2023 to October 2024 were enrolled and divided into two groups:HFrEF-only group(n=84)and HFrEF-T2DM group(n=72),based on the presence of T2DM.Clinical characteristics and TMAO levels were compared between the groups.Correlations among TMAO,hemoglobin A1c(HbA1c),fasting blood glucose(FBG),and N-terminal pro-B-type natriuretic peptide(NT-proBNP)were analyzed.Logistic regression was performed to identify factors influencing T2DM development in HFrEF patients,and the predictive value of TMAO was assessed using receiver operating characteristic(ROC)curve analysis.Results The HFrEF-T2DM group exhibited significantly higher levels of TMAO,left ventricular end-systolic volume(LVESV),left ventricular end-systolic diameter(LVESD),NT-proBNP,FBG,and HbA1c compared to the HFrEF-only group(P＜0.05),while left ventricular ejection fraction(LVEF)was lower(P＜0.05).TMAO levels positively correlated with NT-proBNP(r=0.307,P＜0.05).Multivariate analysis identified TMAO as an independent risk factor for T2DM development in HFrEF patients(OR=1.076,P＜0.05).The area under the curve(AUC)of TMAO for predicting T2DM in HFrEF patients was 0.7298,with an optimal cutoff value of 145.40 g/ml(sensitivity 68.1%,specificity 66.7%).Conclusion TMAO has a high level of activation in HFrEF patients with T2DM,which may be an important indicator to predict the severity of the disease.