The following is a summary of “Association of Systemic Trimethyllysine With Heart Failure With Preserved Ejection Fraction and Cardiovascular Events,” published in the December 2022 issue of Endocrinology & Metabolism by Wei, et al.

Heart failure and cardiac energy metabolism had both been linked to carnitine, however, its precursors trimethyllysine (TML) and γ-butyrobetaine (GBB) had not been linked to heart failure with preserved ejection fraction (HFpEF). For a study, researchers sought to assess the association between HFpEF and TML-related metabolites in an Asian population.

The study explored the connection between plasma TML-related metabolites and HFpEF cross-sectionally, and the association with incident cardiovascular events in HFpEF was investigated using a prospective cohort approach. About 1,000 people who did not have heart failure (non-HF) and 1,413 patients with HFpEF were included in the research. The quantities of plasma carnitine, GBB, TML, and trimethylamine-N-oxide (TMAO) were measured using liquid chromatography-mass spectrometry.

Patients with HFpEF had higher plasma GBB and TML. TML, but not GBB, was substantially linked with HFpEF after controlling for conventional risk variables and renal function. The odds ratio (OR) was 1.57 (95% CI 1.09-2.27; P-trend< .01) for the fourth quartile of TML vs. the first quartile. The odds ratio (OR) for each log-TML SD increase was 1.26 (95% CI 1.08-1.47). The TML-HFpEF connection was changed by plasma TMAO (P-interaction = 0.024) and estimated glomerular filtration rate (P-interaction = 0.024). The multivariable model’s diagnostic value was enhanced by the addition of TML. Greater plasma TML was linked to a higher risk of cardiovascular events in the prospective analysis of HFpEF patients.

Higher plasma TML levels were associated with an increased risk of cardiovascular events and were positively correlated with HFpEF.