Aim. To study the relationship of gut microbiota (GM) composition with clinical and paraclinical characteristics of patients with coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF).Material and methods. The study included 64 patients (men, 71,9%) with CAD, 33 (men, 87,9%) with HFrEF and 38 (men, 63,2%) with various cardiovascular risk factors (control group). GM composition was assessed using real-time polymerase chain reaction and next- generation sequencing. To identify correlations of GM composition with clinical and paraclinical characteristics, the Spearman rank correlation coefficient (ρ) was calculated. Generalized linear models (QuasiPoisson, overdispersion) with covariates (age, body mass index) were used to compare groups by phylotype.Results. The relative abundance of Bacillota phylotypes is significantly higher in patients with CAD and HFrEF compared to controls (p<0,001). The Bacillota/Bacteroidota dysbiosis ratio was also significantly higher in patients with CAD and HFrEF than in the control group (p<0,001). According to correlation analysis, the relative representation of methanogenic archaea Methanomassiliicoccaceae, Methanomethylophilaceae (ρ=0,49, p<0,0003) directly correlated with ventricular arrhythmias in patients with HFrEF.Conclusion. Patients with CAD and HFrEF differ significantly from the control group in GM composition at the phylotype level. In the study groups, Bacillota/Bacteroidota dysbiosis ratio was also significantly higher than in the control group. The relative abundance of the archaea Methanomassiliicoccaceae and Methanomethylophilaceae is associated with episodes of ventricular tachycardia/ventricular fibrillation.