{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:39:10Z","timestamp":1791563950554,"version":"4.3.4"},"reference-count":48,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,4,5]],"date-time":"2025-04-05T00:00:00Z","timestamp":1743811200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Lithuanian University of Health Sciences"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Despite successful primary percutaneous coronary intervention (PPCI), the incidence of heart failure (HF) following ST-elevation myocardial infarction (STEMI) remains high. We investigated using Trimethylamine N-oxide (TMAO), a gut microbiota-derived biomarker, to predict adverse functional left ventricular (LV) remodeling (FLVR) and\/or diastolic dysfunction (DD), which are precursors of HF post-STEMI. This prospective, observational study enrolled 204 STEMI patients with multivessel coronary artery disease after PPCI. TMAO level was collected at the baseline and 3 months. An echocardiography was performed at the baseline and at 12 months. The primary endpoints were the number of patients developing Group 4 FLVR or \u2265Grade II DD at 12 months. The median age was 65 [57.00, 76.00] and 39.7% were women. The primary endpoints occurred in 47 (23.0%) patients. Three months of TMAO can discriminate patients with\/without \u2265Grade II LV DD and FLVR Grade 4 with areas under the curve (AUC) of the ROC of 0.72 (95% CI: 0.63\u20130.81; p &lt; 0.001) and 0.77 (95% CI: 0.63\u20130.91), respectively. Similar results were shown in the validation cohort of 31 patients. The addition of 3 months of TMAO to traditional risk factors significantly improved the AUCs from 0.675 to 0.736 for \u2265Grade II DD and from 0.793 to 0.873 for FLVR Grade 4. In multivariable logistic regression, 3 months of TMAO was independently associated with \u2265Grade II DD (OR: 1.29 (1.13\u20131.50), p &lt; 0.001) and FLVR Grade 4 (OR: 1.28 (1.12\u20131.47), p &lt; 0.001). Three months of TMAO is strongly associated with LV DD and adverse remodeling after STEMI and may help identifying such patients for early treatment.<\/jats:p>","DOI":"10.3390\/ijms26073400","type":"journal-article","created":{"date-parts":[[2025,4,9]],"date-time":"2025-04-09T07:49:02Z","timestamp":1744184942000},"page":"3400","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Trimethylamine N-Oxide as a Biomarker for Left Ventricular Diastolic Dysfunction and Functional Remodeling After STEMI"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0426-9360","authenticated-orcid":false,"given":"Tsung-Ying","family":"Tsai","sequence":"first","affiliation":[{"name":"CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, H91 TK33 Galway, Ireland"},{"name":"Cardiovascular Center, Taichung Veterans General Hospital, Taichung 407219, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5567-2221","authenticated-orcid":false,"given":"Ali","family":"Aldujeli","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7093-420X","authenticated-orcid":false,"given":"Ayman","family":"Haq","sequence":"additional","affiliation":[{"name":"Abbott Northwestern Hospital\/Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paddy","family":"Murphy","sequence":"additional","affiliation":[{"name":"CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, H91 TK33 Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramunas","family":"Unikas","sequence":"additional","affiliation":[{"name":"Institute of Cardiology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0086-4864","authenticated-orcid":false,"given":"Faisal","family":"Sharif","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Hospital Galway, University of Galway, H91 YR71  Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8911-0278","authenticated-orcid":false,"given":"Scot","family":"Garg","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Royal Blackburn Hospital, Blackburn BB2 3HH, UK"},{"name":"School of Medicine, University of Central Lancashire, Preston PR1 2HE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanouil S.","family":"Brilakis","sequence":"additional","affiliation":[{"name":"Abbott Northwestern Hospital\/Minneapolis Heart Institute Foundation, Minneapolis, MN 55407, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshinobu","family":"Onuma","sequence":"additional","affiliation":[{"name":"CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, H91 TK33 Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9636-1104","authenticated-orcid":false,"given":"Patrick W.","family":"Serruys","sequence":"additional","affiliation":[{"name":"CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, H91 TK33 Galway, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,4,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e002667","DOI":"10.1161\/JAHA.115.002667","article-title":"Heart Failure Complicating Acute Myocardial Infarction; Burden and Timing of Occurrence: A Nation-wide Analysis Including 86 771 Patients from the Cardiovascular Disease in Norway (CVDNOR) Project","volume":"5","author":"Sulo","year":"2016","journal-title":"J. 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