Aims
The aim of this study was to investigate whether ethnicity influences the associations between trimethylamine N‐oxide (TMAO) levels and heart failure (HF) outcomes.
Methods and results
...Trimethylamine N‐oxide levels were measured in two cohorts with acute HF at two sites. The UK Leicester cohort consisted mainly of Caucasian (n = 842, 77%) and South Asian (n = 129, 12%) patients, whereas patients in the Japanese cohort (n = 116, 11%) were all Japanese. The primary endpoint was the measurement of all‐cause mortality and/or HF rehospitalization within 1 year post‐admission. Association of TMAO levels with outcome was compared in the entire population and between ethnic groups after adjustment for clinical parameters. TMAO levels were significantly higher in Japanese patients median (interquartile range): 9.9 μM (5.2–22.8) than in Caucasian 5.9 μM (3.6–10.8) and South Asian 4.5 μM (3.1–8.4) (P < 0.001) patients. There were no differences in the rate of mortality and/or HF rehospitalization between the ethnic groups (P = 0.096). Overall, higher TMAO levels showed associations with mortality and/or rehospitalization after adjustment for confounders ( P = 0.002). Despite no differences between ethnicity and association with mortality/HF after adjustment (P = 0.311), only in Caucasian patients were TMAO levels able to stratify for a mortality/HF event (P < 0.001).
Conclusions
Differences were observed in the association of mortality and/or rehospitalization based on circulating TMAO levels. Elevated TMAO levels in Caucasian patients showed increased association with adverse outcomes, but not in non‐Caucasian patients.
Summary Background Chronic kidney disease (CKD) is associated with poor outcomes after percutaneous coronary intervention (PCI). This study aimed to evaluate the relationship between the degree of ...renal function at baseline and long-term clinical outcomes in coronary artery disease patients who underwent paclitaxel-eluting stent implantation. Methods A total of 336 patients with 400 de-novo lesions underwent PCI between May 2007 and March 2009. The patients were divided into 4 groups: control (glomerular filtration rate (GFR) ≧90 ml/min; n = 132); mild CKD (GFR 60–89 ml/min; n = 112); moderate CKD (GFR <60 ml/min; n = 51); and dialysis ( n = 41). All lesions were treated using a paclitaxel-eluting stent. The primary and secondary endpoints were incidences of mortality and major adverse cardiovascular events (MACE) during 2 years after PCI and target vessel revascularization (TVR), respectively. Results Two-year MACE incidence rates were 9.7%, 15.2%, 30%, and 31% in control, mild CKD, moderate CKD, and dialysis groups, respectively. TVR trended upward with increasing renal impairment (8.3%, 12.5%, 18%, and 21.4% for the 4 groups, respectively, p = 0.09). Mild CKD, moderate CKD, and dialysis patients had adjusted hazard ratios of 2.51 (95% CI, 1.01–6.24); 3.20 (95% CI, 1.07–9.60); and 4.19 (95% CI, 1.30–13.51), respectively, for 2-year MACE. Conclusions A graded relationship was observed between lower renal function and increased TVR, although it did not reach statistical significance. Cardiac death and TVR rates were significantly higher in moderate CKD and dialysis patients after paclitaxel-eluting stent implantation. Patients with reduced renal function, even mild CKD, were independent predictors of MACE.
Background Matrix-assisted laser desorption ionisation (MALDI) mass spectrometry (MS) has been used for more than 30 years. Compared with other analytical techniques, it offers ease of use, high ...throughput, robustness, cost-effectiveness, rapid analysis and sensitivity. As advantages, current clinical techniques (e.g. immunoassays) are unable to directly measure the biomarker; rather, they measure secondary signals. MALDI-MS has been extensively researched for clinical applications, and it is set for a breakthrough as a routine tool for clinical diagnostics. Content This review reports on the principles of MALDI-MS and discusses current clinical applications and the future clinical prospects for MALDI-MS. Furthermore, the review assesses the limitations currently experienced in clinical assays, the advantages and the impact of MALDI-MS to transform clinical laboratories. Summary MALDI-MS is widely used in clinical microbiology for the screening of microbial isolates; however, there is scope to apply MALDI-MS in the diagnosis, prognosis, therapeutic drug monitoring and biopsy imaging in many diseases. Outlook There is considerable potential for MALDI-MS in clinic as a tool for screening, profiling and imaging because of its high sensitivity and specificity over alternative techniques.
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