Re-defining the Gut Heart Axis: A Systematic Review of the Literature on the Role of Gut Microbial Dysbiosis in Patients With Heart Failure

Abstract

Heart failure (HF) contributes to the cardiovascular health burden worldwide. Patients with heart failure have been recently studied to possess unique changes in the gut microbiome that affect immune homeostasis and metabolism. In this systematic review of the literature, we aim to identify the impact of gut dysbiosis on heart failure. We used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines to conduct our systematic review. We searched the literature on databases such as PubMed, PubMed Central (PMC), Medline, and ScienceDirect. Ten articles were included for review. There were significant differences in the gut microbiome composition in heart failure. Relative abundance of Ruminococcus gnavus, Escherichia Shigella, Streptococcus sp, Veillonella sp, and Actinobacteria, and relative depletion of Eubacterium, Prevotella, Faecalibacterium, SMB53, and Megamonas. The composition varied according to age, heart failure stage, and decompensation level. The composition remained unaltered with ejection fraction. There was an increased expression of genes responsible for the metabolism of amino acids, carbohydrates, choline trimethylamine-lyase (TMA-lyase), lipopolysaccharide (LPS) biosynthesis, tryptophan, and lipid metabolism. The resultant changes affected the levels of metabolites, such as trimethylamine N-oxide (TMAO), indoxyl sulfate (IS), and LPS, and inflammatory markers in the feces and plasma, which contributed to heart failure. These biomarkers of heart failure could serve as targets for the prevention and treatment of heart failure. Patients with heart failure harbor a unique constellation of gut microbiota that affect the pathogenesis of heart failure. Further studies are needed to understand the causal relationship between dysbiosis and heart failure.

Kynurenines in Heart Failure With Preserved Ejection Fraction: An Influence of Type 2 Diabetes

“…The potential explanation behind our observation of increased TRP levels in the HFpEF group and even higher in cohorts with T2D and HFpEF can be unique changes in the gut microbiome of patients with HF and diabetes that alters immune homeostasis and metabolism leading to the development of HF. It has been shown that dysbiosis-through a shift in bacterial catabolism to proteolytic fermentation especially by Clostridium sporogenes and Escherichia coli-produces indole-derived metabolites and TRP; and the link with cardiotoxicity and vascular in ammation has been found previously [30,31,32]. A useful parameter assessing the integrity of the intestinal mucosal barrier would be the determination of zonulin concentration in serum, but it was not performed at this stage of the study and needs to be con rmed in further studies.…”

How a Plant-Based Diet (PBD) Reduces In-Stent Restenosis (ISR) and Stent Thrombosis (ST)

“…Certainly, an omnivorous diet that is low in fiber, devoid of polyphenols and phytochemicals, and deficient in SCFAs while being high in TMAO can contribute to the development of new atherosclerotic plaques and increase the incidence of ISR and ST in patients who have undergone coronary interventions. Thus, the gut and the heart interaction is known as the gut-heart axis [59,60].…”

Unraveling the Microbiome–Human Body Axis: A Comprehensive Examination of Therapeutic Strategies, Interactions and Implications

“…Also, the mechanisms through which FMT influences disease processes, including its effects on immune modulation, metabolic pathways, and neurobehavioral outcomes, are not fully understood. In general, the gut microbiota is capable of communication with distant organs via the gut-brain axis, gut-liver axis, and gut-heart axis among others [344,345]. Therefore, the effects of gut microbiota dysbiosis on the host would be expressed through the modulation of the endocrine and immune systems [344].…”