Plasma TMAO and Cardiac Troponin Levels

Informed consent was obtained from all patients and fasting blood samples were collected using EDTA tubes at the time of hospital visit. These were then immediately processed and frozen at − 80 °C until analysis. Plasma TMAO levels were determined using an NMR spectrometer at 400 MHz (Bruker, USA). The Carr-Purcell-Meiboom-Gill (CPMG) pulse sequence was employed to obtain spectra (recycle delay-90°-t1-90°-tm-90°-acquisition) over 64 scans with four dummy scans. Quantification was achieved using a concentration of a known reference signal (in this case TSP) to determine the TMAO concentration. hs-cTnT was measured using a high-sensitivity (5^th generation) assay on a Roche Cobas e411 platform (Roche Diagnostics, Basel, Switzerland). We defined SMD as hs-cTnT ≥ 14 ng/L, as this is considered the upper limit (the 99^th percentile) of the normal range in the healthy population^{19 (link)}. eGFR was calculated using the modification of diet in renal disease (MDRD) equation.