Chuanjie Wu1, Chuanhui Li1, Wenbo Zhao1, Nanchang Xie1, Feng Yan1, Yajun Lian1, Li Zhou1, Xiaoya Xu1, Yong Liang1, Lu Wang1, Ming Ren1, Sijie Li1, Xuan Cheng1, Lu Zhang1, Qingfeng Ma1, Haiqing Song1, Ran Meng1, Xunming Ji2. 1. From the Departments of Neurology (C.W., W.Z., M.R., Q.M., H.S., R.M.), Neurosurgery (C.L., F.Y., X.J.), and Emergency (S.L.), Xuanwu Hospital Capital Medical University, Beijing; Department of Neurology (N.X., Y. Lian, X.C., L. Zhang), The First Affiliated Hospital of Zhengzhou University; Department of Neurology (L. Zhou), Luzhou People's Hospital; Department of Neurology (X.X.), Zigong First People's Hospital; Department of Neurology (Y. Liang), Xiangtan Central Hospital; and Department of Neurology (L.W.), Guizhou Provincial People's Hospital, China. 2. From the Departments of Neurology (C.W., W.Z., M.R., Q.M., H.S., R.M.), Neurosurgery (C.L., F.Y., X.J.), and Emergency (S.L.), Xuanwu Hospital Capital Medical University, Beijing; Department of Neurology (N.X., Y. Lian, X.C., L. Zhang), The First Affiliated Hospital of Zhengzhou University; Department of Neurology (L. Zhou), Luzhou People's Hospital; Department of Neurology (X.X.), Zigong First People's Hospital; Department of Neurology (Y. Liang), Xiangtan Central Hospital; and Department of Neurology (L.W.), Guizhou Provincial People's Hospital, China. jixm@ccmu.edu.cn.
Abstract
OBJECTIVES: To investigate whether the plasma level of trimethylamine N-oxide (TMAO), a proatherosclerotic intestinal microbiota metabolite, can be a predictor of ischemic brain injury secondary to carotid artery stenting (CAS). METHODS: In this multicenter, prospective cohort study, we enrolled patients with severe carotid artery stenosis (>70%) who were prepared for CAS. Plasma TMAO level was measured within 3 days before CAS, and MRI was performed 1 to 3 days after CAS. RESULTS: The mean age of the 268 eligible patients was 64.4 years. New lesions on diffusion-weighted imaging (DWI) were detected in 117 patients (43.7%). TMAO level was higher in patients with new (DWI) lesions than in patients without new lesions (median 5.2 vs 3.2 µmol/L; p < 0.001). Increased plasma TMAO levels were associated with an increased risk of having new lesions on DWI after CAS (adjusted odds ratio for the highest vs lowest quartile, 3.85; 95% confidence interval, 1.37-7.56, p < 0.001; adjusted odds ratio for the third vs lowest quartile, 1.86; 95% confidence interval, 1.09-4.66, p = 0.02). The area under the receiver operating characteristic curve of TMAO was 0.706 for new lesions on DWI, and the optimal cutoff value was 4.29 µmol/L. The sensitivity, specificity, positive predictive value, and negative predictive value of TMAO levels ≥4.29 µmol/L for predicting new lesions on DWI were 61.5%, 74.8%, 65.5%, and 65.5%, respectively. CONCLUSIONS: Increased TMAO levels are associated with an increased risk of new ischemic brain lesions on post-CAS MRI scans.
OBJECTIVES: To investigate whether the plasma level of trimethylamine N-oxide (TMAO), a proatherosclerotic intestinal microbiota metabolite, can be a predictor of ischemic brain injury secondary to carotid artery stenting (CAS). METHODS: In this multicenter, prospective cohort study, we enrolled patients with severe carotid artery stenosis (>70%) who were prepared for CAS. Plasma TMAO level was measured within 3 days before CAS, and MRI was performed 1 to 3 days after CAS. RESULTS: The mean age of the 268 eligible patients was 64.4 years. New lesions on diffusion-weighted imaging (DWI) were detected in 117 patients (43.7%). TMAO level was higher in patients with new (DWI) lesions than in patients without new lesions (median 5.2 vs 3.2 µmol/L; p < 0.001). Increased plasma TMAO levels were associated with an increased risk of having new lesions on DWI after CAS (adjusted odds ratio for the highest vs lowest quartile, 3.85; 95% confidence interval, 1.37-7.56, p < 0.001; adjusted odds ratio for the third vs lowest quartile, 1.86; 95% confidence interval, 1.09-4.66, p = 0.02). The area under the receiver operating characteristic curve of TMAO was 0.706 for new lesions on DWI, and the optimal cutoff value was 4.29 µmol/L. The sensitivity, specificity, positive predictive value, and negative predictive value of TMAO levels ≥4.29 µmol/L for predicting new lesions on DWI were 61.5%, 74.8%, 65.5%, and 65.5%, respectively. CONCLUSIONS: Increased TMAO levels are associated with an increased risk of new ischemic brain lesions on post-CAS MRI scans.
Authors: Luigi Barrea; Giuseppe Annunziata; Laura Bordoni; Giovanna Muscogiuri; Annamaria Colao; Silvia Savastano Journal: Int J Obes Suppl Date: 2020-07-20
Authors: Baris Gencer; Xinmin S Li; Yared Gurmu; Marc P Bonaca; David A Morrow; Marc Cohen; Deepak L Bhatt; P Gabriel Steg; Robert F Storey; Per Johanson; Zeneng Wang; Stanley L Hazen; Marc S Sabatine Journal: J Am Heart Assoc Date: 2020-05-05 Impact factor: 5.501