{
  "abstract": "BackgroundRisk stratification for primary ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with ST-elevation myocardial infarction (STEMI) remains limited. We aimed to identify gut microbiome biomarkers and microbial metabolic pathways associated with primary VT/VF in STEMI using machine learning (ML).\n\nMethodsStool samples from 33 STEMI patients (7 with primary VT/VF and 26 without VT/VF) underwent full-length 16S rRNA sequencing during the acute ([≤]7 days) and recovery (30-60 days) phases. An ML pipeline integrating taxonomic features identified reproducible features associated with primary VT/VF. Core biomarkers were defined as taxa demonstrating both univariate significance (false discovery rate [FDR] <0.05) and multivariate classification importance. Functional pathways and enzymes were predicted using PICRUSt2.\n\nResultsFive acute-phase taxa were reproducibly associated with primary VT/VF: Clostridium aldenense, Enterocloster bolteae, bacterium NLAE-zl-G101, Alistipes shahii, and Roseburia sp. (all FDR <0.05). A reduced-feature support vector machine model achieved an area under the receiver operating characteristic curve of 0.846 (95% confidence interval, 0.676-0.984), with 85.7% sensitivity and 76.9% specificity. Differential abundance analysis showed enrichment of Bacteroides fragilis, Bacteroides thetaiotaomicron, and E. bolteae. Functional analysis demonstrated enrichment of fucose degradation and purine catabolism, with increased predicted abundances of L-fucose mutarotase and xanthine dehydrogenase.\n\nConclusionsPrimary VT/VF in STEMI was associated with a distinct gut microbiome-metabolic signature characterized by Lachnoclostridium-related taxa, persistent Bacteroides enrichment, and enhanced predicted fucose and purine metabolism. These exploratory findings warrant validation in larger independent cohorts and mechanistic studies.\n\nClinical PerspectiveWhat Is New? O_LIIn this exploratory cohort of 33 patients with STEMI, including 7 with primary VT/VF, an integrated microbiome and machine-learning framework identified five acute-phase microbial taxa associated with primary VT/VF and a coordinated predicted metabolic signature involving fucose and purine pathways. C_LI\n\nWhat Are the Clinical Implications? O_LIBecause stool sampling occurred after the arrhythmic event and the VT/VF subgroup was small, these findings should be considered hypothesis-generating rather than predictive; independent prospective validation is required before microbiome-derived markers can be considered for clinical risk stratification. C_LI",
  "abstract_shown": true,
  "affiliations": [
    "Superintendent of Taichung Municipal Geriatric Rehabilitation General Hospital"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "name": "H.-P. Tseng"
    },
    {
      "name": "Z.-L. Lai"
    },
    {
      "name": "Y.-Y. Hsu"
    },
    {
      "name": "Y.-H. Hung"
    },
    {
      "name": "D.-Y. Cho"
    },
    {
      "name": "P.-R. Hsueh"
    },
    {
      "name": "W.-H. Chung"
    },
    {
      "name": "M.-Y. Wu"
    },
    {
      "name": "Y.-N. Lin"
    },
    {
      "name": "K.-W. Chen"
    },
    {
      "affs": [
        0
      ],
      "name": "S.-S. Chang"
    },
    {
      "affs": [
        0
      ],
      "name": "K.-C. Chang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a40tmyb36qbh9.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.09.16.26363271",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.09.16.26363271v1.full",
  "id": "a40tmyb36qbh9",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.09.16.26363271v1",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "cardiovascular medicine"
    ],
    [
      "openalex",
      "1312|Gut microbiota and health"
    ]
  ],
  "openalex": "W7213745847",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.09.16.26363271v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-09-16",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/a40tmyb36qbh9.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:56Z",
      "native_id": "10.64898/2026.09.16.26363271",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.09.16.26363271v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:cardiovascular medicine",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Machine Learning Approach to Identify Gut Microbiota Biomarkers in Patients with ST-Elevation Myocardial Infarction Presenting Primary Ventricular Tachyarrhythmias",
  "title_text": "Machine Learning Approach to Identify Gut Microbiota Biomarkers in Patients with ST-Elevation Myocardial Infarction Presenting Primary Ventricular Tachyarrhythmias",
  "type": "preprint",
  "updated_at": "2026-10-30T12:18:56Z",
  "url": "https://research.draconitic.com/paper/a40tmyb36qbh9",
  "venue": "medRxiv",
  "versions": []
}