ArticleJournal of the American College of Cardiology2014
Prognostic value of elevated levels of intestinal microbe-generated metabolite trimethylamine-N-oxide in patients with heart failure: refining the gut hypothesis.
Article in Journal of the American College of Cardiology, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 390 papers, 8 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
390 citing papers in PubMed, 8 syntheses or guidelines pooled it, 669 citations in OpenAlex.
- The association between the gut microbiota metabolite trimethylamine N-oxide and heart failure.Frontiers in microbiology · 2024Pooled it
- Impacts of intestinal microbiota metabolite trimethylamine N-oxide on cardiovascular disease: a bibliometric analysis.Frontiers in microbiology · 2024Pooled it
- Significant correlation between the gut microbiota-derived metabolite trimethylamine-N-oxide and the risk of stroke: evidence based on 23 observational studies.European journal of clinical nutrition · 2023Pooled it
- Carnitine supplements for people with chronic kidney disease requiring dialysis.The Cochrane database of systematic reviews · 2022Pooled it
- The heart and gut relationship: a systematic review of the evaluation of the microbiome and trimethylamine-N-oxide (TMAO) in heart failure.Heart failure reviews · 2022Pooled it
- Gut microbiota-derived metabolite trimethylamine-N-oxide and multiple health outcomes: an umbrella review and updated meta-analysis.The American journal of clinical nutrition · 2022Pooled it
- Trimethylamine N-Oxide in Heart Failure: A Meta-Analysis of Prognostic Value.Frontiers in cardiovascular medicine · 2022Pooled it
- Gut Microbiota-Derived Trimethylamine N-Oxide and Kidney Function: A Systematic Review and Meta-Analysis.Advances in nutrition (Bethesda, Md.) · 2021Pooled it
- Low Bioavailability and High TMAO Production: Novel Insights Into Acetylcarnitine and Carnitine Metabolism.Molecular nutrition & food research · 2025Trial
- Effect of dietary fiber on trimethylamine-N-oxide production after beef consumption and on gut microbiota: MEATMARK - a randomized cross-over study.European journal of clinical nutrition · 2025Trial
- Changes in Choline Metabolites and Ceramides in Response to a DASH-Style Diet in Older Adults.Nutrients · 2023Trial
- Trimethylamine N-oxide and major adverse cardiac and cerebrovascular events: results of umbrella review and meta-analysis.Nutrition & metabolism · 2026Article
- Targeting the Gut Microbiome in Cardiovascular Disease: Current Therapeutic Strategies and Future Perspectives.Nutrients · 2026Review
- The Gut-Heart-Kidney Axis in Heart Failure: Trimethylamine N-Oxide and Beyond-A State-of-the-Art Review.Biomedicines · 2026Review
- From Fecal Microbial Potential to Circulating Trimethylamine N-oxide and Cardiovascular Events: A Narrative Review.Cureus · 2026Review
- The gut-heart axis in cardio-oncology.Cardiovascular research · 2026Review
- The gut microbiome and allograft outcomes: implications for heart transplantation.The Journal of clinical investigation · 2026Review
- Paraoxonases as metabolic and signaling modulators: prospects for therapeutic and preventive implications.npj metabolic health and disease · 2026Review
- Blood-Based Biomarkers for Post-Stroke Cognitive Impairment.Current issues in molecular biology · 2026Review
- The Gut Microbiome in Heart Failure: Pathways to Inflammation and Therapeutic Targets.Metabolites · 2026Review
330 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
8 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundAltered intestinal function is prevalent in patients with heart failure (HF), but its role in adverse outcomes is unclear.
objectivesThis study investigated the potential pathophysiological contributions of intestinal microbiota in HF.
methodsWe examined the relationship between fasting plasma trimethylamine-N-oxide (TMAO) and all-cause mortality over a 5-year follow-up in 720 patients with stable HF.
resultsThe median TMAO level was 5.0 μM, which was higher than in subjects without HF (3.5 μM; p < 0.001). There was modest but significant correlation between TMAO concentrations and B-type natriuretic peptide (BNP) levels (r = 0.23; p < 0.001). Higher plasma TMAO levels were associated with a 3.4-fold increased mortality risk. Following adjustments for traditional risk factors and BNP levels, elevated TMAO levels remained predictive of 5-year mortality risk (hazard ratio [HR]: 2.2; 95% CI: 1.42 to 3.43; p < 0.001), as well as following the addition of estimated glomerular filtration rate to the model (HR: 1.75; 95% CI: 1.07 to 2.86; p < 0.001).
conclusionsHigh TMAO levels were observed in patients with HF, and elevated TMAO levels portended higher long-term mortality risk independent of traditional risk factors and cardiorenal indexes.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.