The Role of Gut Microbiota in Heart Failure and Pre-Heart Failure With Preserved Ejection Fraction

Gut microbiota play an important role in normal cardiovascular function and pathophysiology
of cardiovascular diseases. Patients with heart failure (HF) have substantial hemodynamic
changes which lead to intestinal hypoperfusion and congestion and eventually change gut
morphology, permeability, function and composition of gut microbiota and cause translocation
of microbial and endotoxins into the blood stream. Additionally, metabolites derived from gut
microbiota modulate the pathophysiology of HF. Patients with HF have intestinal overgrowth of
pathogenic bacteria and increased gut permeability. Accumulating evidence demonstrates that
antibiotic treatment benefits patients with acute coronary syndromes and reduces the
incidence of ischemic cardiovascular events. Taking the strong association of gut microbiota
with HF into account, it is reasonable to speculate that gut microbiota could contribute to
the progression of pre-HF with preserved ejection fraction (pre-HFpEF) to HF with preserved
ejection fraction (HFpEF). Pre-HFpEF remains poorly understood, yet has high prevalence and a
significantly high risk for death in comparison to patient without pre-HFpEF. We hypothesize
that altered gut microbiota is involved in the initiation and establishment of HF and
pre-HFpEF.