2134/12587492.v1 Yoshiyuki Yazaki Yoshiyuki Yazaki K Aizawa K Aizawa K Negishi K Negishi Andrea Salzano Andrea Salzano Y Saitoh Y Saitoh K Kono K Kono Muhammed Zubair Israr Muhammed Zubair Israr Liam Heaney Liam Heaney Y Imai Y Imai K Kario K Kario R Nagai R Nagai Leong Ng Leong Ng Toru Suzuki Toru Suzuki Ethnic differences in associations of outcomes with trimethylamine N-oxide in acute heart failure patients Loughborough University 2020 Cardiorespiratory Medicine and Haematology Outcomes Gut metabolite TMAO Ethnicity Heart failure 2020-06-30 09:58:39 Journal contribution https://repository.lboro.ac.uk/articles/journal_contribution/Ethnic_differences_in_associations_of_outcomes_with_trimethylamine_N-oxide_in_acute_heart_failure_patients/12587492 <div>Aims The aim of this study was to investigate whether ethnicity influences the associations between trimethylamine N-oxide (TMAO) levels and heart failure (HF) outcomes. Methods and results Trimethylamine N-oxide levels were measured in two cohorts with acute HF at two sites. The UK Leicester cohort consisted mainly of Caucasian (n = 842, 77%) and South Asian (n = 129, 12%) patients, whereas patients in the Japanese cohort (n = 116, 11%) were all Japanese. The primary endpoint was the measurement of all-cause mortality and/or HF rehospitalization within 1 year post-admission. Association of TMAO levels with outcome was compared in the entire population and between ethnic groups after adjustment for clinical parameters. TMAO levels were significantly higher in Japanese patients [median (interquartile range): 9.9 μM (5.2–22.8)] than in Caucasian [5.9 μM (3.6–10.8)] and South Asian [4.5 μM (3.1–8.4)] (P < 0.001) patients. There were no differences in the rate of mortality and/or HF rehospitalization between the ethnic groups (P = 0.096). Overall, higher TMAO levels showed associations with mortality and/or rehospitalization after adjustment for confounders ( P = 0.002). Despite no differences between ethnicity and association with mortality/HF after adjustment (P = 0.311), only in Caucasian patients were TMAO levels able to stratify for a mortality/HF event (P < 0.001). Conclusions Differences were observed in the association of mortality and/or rehospitalization based on circulating TMAO levels. Elevated TMAO levels in Caucasian patients showed increased association with adverse outcomes, but not in non-Caucasian patients.</div>