Association of plasma trimethylamine oxide and its precursors with heart failure with preserved ejection fraction

Song Yulong; Li Qing; Bao Yu; Wang Xianliang; Zhao Zhiqiang

doi:10.3760/j.issn.1673-4777.2025.11.004

Abstract：Objective To investigate the correlation and diagnostic value of plasma trimethylamine oxide(TMAO)and its precursors with heart failure with preserved ejection fraction(HFpEF).Methods A total of 66 patients with chronic heart failure in First Teaching Hospital of Tianjin University of Traditional Chinese Medicine from August to December 2015 were selected as the research objects.According to the diagnostic criteria of heart failure,they were divided into HFpEF group(32 cases)and HFrEF group(34 cases).At the same time,40 patients with non-heart failure(NHF)admitted to our hospital during the same period were selected as the NHF group.The levels of TMAO,trimethylamine,choline,betaine and L-carnitine in plasma were detected by liquid chromatography-mass spectrometry.Combined with echocardiographic indicators and biomarkers,Pearson correlation analysis and receiver operating characteristic(ROC)curve were used to evaluate the diagnostic value of TMAO and its precursors for HFpEF.Results Compared with NHF group,the plasma levels of TMAO,trimethylamine and choline in HFpEF and HFrEF group were significantly increased,and those in HFpEF group were higher than HFrEF group(all P＜0.05).The level of L-carnitine in HFpEF group was significantly higher than that in NHF group(P＜0.05).There was no significant difference in betaine levels among the three groups(P＞0.05).Correlation analysis showed that TMAO level was positively correlated with tissue inhibitor of metalloproteinase-1(r=0.360,P＜0.05)and negatively correlated with estimated glomerular filtration rate(r=-0.449,P＜0.05).ROC curve analysis showed that the area under the curve(AUC)of TMAO for the diagnosis of HFpEF was 0.812,the sensitivity was 90.6％,and the specificity was 67.5％.The AUC of trimethylamine in the diagnosis of HFpEF was 0.920,the sensitivity was 87.5％,and the specificity was 87.5％.The AUC of choline in the diagnosis of HFpEF was 0.941,the sensitivity was 87.5％,and the specificity was 97.5％.The AUC of L-carnitine in the diagnosis of HFpEF was 0.694,the sensitivity was 65.6％,and the specificity was 70.0％.Conclusion TMAO and its precursors(trimethylamine,choline,L-carnitine)are correlated with HFpEF and may be potential biomarkers for the auxiliary diagnosis of HFpEF,but their clinical application needs to be further verified.