Expression of plasma trimethylamine oxide in patients with acute coronary syndrome and its correlation with disease severity / 中国医师进修杂志

ABSTRACT

Objective:To investigate the correlation between the plasma trimethylamine oxide (TMAO) level and the disease severity in patients with acute coronary syndrome (ACS).Methods:The clinical data of 200 patients with ACS (ACS group) and 90 chest discomfort patients without obvious coronary artery disease (control group) in Department of Cardiology Medicine, the First People′s Hospital of Tianmen City, Hubei Province, from June 2018 to June 2019 were retrospectively analyzed. The plasma TMAO level were detected by high performance liquid chromatography tandem spectroscopy with stable isotope dilution. Left ventricular ejection fraction (LVEF), left ventricle diameter (LAD), left ventricular posterior wall end-systolic thickness (PWS) and left ventricular posterior wall end-diastolic thickness (LVPWT) were examined by color ultrasound. The diagnostic value of plasma TMAO for ACS was analyzed by receiver operating characteristic (ROC) curve. Correlation was analyzed by Pearson correlation analysis.Results:The TMAO, LAD, PWS and LVPWT in ACS group were significantly higher than those in control group (6.33 ± 1.31) μmol/L vs. (3.75 ± 1.11) μmol/L, (39.63 ± 8.89) mm vs. (31.90 ± 8.79) mm, (12.88 ± 1.76) mm vs. (7.00 ± 1.27) mm and (13.45 ± 2.51) mm vs. (8.97 ± 2.00) mm, the LVEF was significantly lower than that in control group (44.63 ± 10.00)% vs. (59.71 ± 11.58)%, and there were statistical differences ( P<0.01). ROC curve analysis result showed that when the optimal cutoff value of plasma TMAO was 4.83 μmol/L, the area under curve (AUC) was 0.942, and its sensitivity and specificity for diagnosing ACS were 87.50% and 88.89%; when the optimal cutoff value of plasma TMAO was 4.66 μmol/L, the AUC was 0.908, and its sensitivity and specificity of early diagnosis of ACS were 88.00% and 83.33%. The correlation analysis result showed that the plasma TMAO had negative correlation with LVEF in patients with ACS ( r=-0.715, P<0.01), and positive correlation with LAD, PWS and LVPWT ( r=0.715, 0.746 and 0.729; P<0.01). Conclusions:The plasma TMAO level in patients with ACS is significantly increased, which is related to the level of heart function. Plasma TMAO can be used as an indicator of early diagnosis and severity assessment of ACS.