ArticleESC heart failure2021
Trimethylamine N-oxide and outcomes in patients hospitalized with acute heart failure and preserved ejection fraction.
Article in ESC heart failure, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06645535 (The Role and Mechanism of Gut Microbiota and Metabolites in Heart Failure With Preserved Ejection Fraction), which is not on this map. Cited by 30 papers, 4 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.
The Role and Mechanism of Gut Microbiota and Metabolites in Heart Failure With Preserved Ejection Fraction
Who cites it
30 citing papers in PubMed, 4 syntheses or guidelines pooled it, 43 citations in OpenAlex.
- Gut microbiota-derived trimethylamine N-oxide and the incidence and recurrence of atrial fibrillation: a systematic review and meta-analysis.Frontiers in cardiovascular medicine · 2026Pooled it
- The association between the gut microbiota metabolite trimethylamine N-oxide and heart failure.Frontiers in microbiology · 2024Pooled 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 (TMAO) as a prognostic marker among patients at nutritional risk. A secondary analysis of the randomized clinical trial EFFORT.European journal of clinical nutrition · 2026Trial
- The Gut-Heart-Kidney Axis in Heart Failure: Trimethylamine N-Oxide and Beyond-A State-of-the-Art Review.Biomedicines · 2026Review
- Candidate Residual Inflammatory Risk in HFpEF: A Multiorgan Framework for Longitudinal Phenotyping, Trial Enrichment, and Therapeutic Evidence Appraisal.Cardiovascular drugs and therapy · 2026Review
- Metabolic Dysfunction-Associated Steatotic Liver Disease as a Systemic Driver of Heart Failure With Preserved Ejection Fraction: Mechanistic Insights and Emerging Therapeutic Perspectives.Reviews in cardiovascular medicine · 2026Review
- Gut Microbiota-Derived Trimethylamine N-Oxide and NT-proBNP in Heart Failure: A Critical Review of Diagnostic and Prognostic Value.Biomedicines · 2026Review
- Role of Gut Microbiota in Diabetic HFpEF: Mechanisms and Therapeutic Implications.Diabetes, metabolic syndrome and obesity : targets and therapy · 2026Review
- Gut microbiota's role in heart failure.Heart failure reviews · 2025Review
- From Gut to Heart: Targeting Trimethylamine N-Oxide as a Novel Strategy in Heart Failure Management.Biomolecules · 2025Review
- TMAO and Cardiovascular Disease: Exploring Its Potential as a Biomarker.Medicina (Kaunas, Lithuania) · 2025Review
- Metabolic rewiring and inter-organ crosstalk in diabetic HFpEF.Cardiovascular diabetology · 2025Review
- The gut microbiota-inflammation-HFpEF axis: deciphering the role of gut microbiota dysregulation in the pathogenesis and management of HFpEF.Frontiers in cellular and infection microbiology · 2025Review
- Decoding TMAO in the Gut-Organ Axis: From Biomarkers and Cell Death Mechanisms to Therapeutic Horizons.Drug design, development and therapy · 2025Review
- Microbiome-Derived Trimethylamine N-Oxide (TMAO) as a Multifaceted Biomarker in Cardiovascular Disease: Challenges and Opportunities.International journal of molecular sciences · 2024Review
- Trimethylamine N-oxide: a meta-organismal axis linking the gut and fibrosis.Molecular medicine (Cambridge, Mass.) · 2024Review
- Interactions between the gut microbiome, associated metabolites and the manifestation and progression of heart failure with preserved ejection fraction in ZSF1 rats.Cardiovascular diabetology · 2024Article
- TrimethylamineCirculation. Heart failure · 2024Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsTrimethylamine N-oxide (TMAO) is a metabolite derived from the gut microbiota. Elevated TMAO levels are associated with a poor prognosis in patients with heart failure with reduced ejection fraction. However, the prognostic effect of elevated TMAO levels on heart failure with preserved ejection fraction (HFpEF) remains unclear. METHODS AND
resultsWe consecutively enrolled 146 patients who were hospitalized and discharged from Tottori University Hospital with the primary diagnosis of HFpEF (ejection fraction ≥ 50%). High TMAO levels were defined as those greater than the median value in the patients (20.37 μmol/L). Patients with high TMAO levels had a significantly higher prevalence of prior hospitalization for heart failure and severe renal dysfunction than those with low TMAO levels. They also had a significantly higher acylcarnitine to free carnitine ratio than those with low TMAO levels, which indicated abnormal fatty acid metabolism and relative carnitine deficiency. After adjustment for differences in the patients' background in multivariate analysis, high TMAO levels remained independently associated with a high incidence of the composite endpoints of death due to cardiac causes and hospitalization for heart failure (adjusted hazard ratio, 1.91; 95% confidence interval, 1.01 to 3.62; P < 0.05). There was a significant interaction between TMAO and nutritional status on the primary outcome, and the prognostic effect of TMAO was enhanced in patients with malnutrition.
conclusionsElevated TMAO levels at discharge are associated with an increased risk of post-discharge cardiac events in patients with HFpEF, especially those with the complication of malnutrition.
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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.