Comprehensive Analysis of Gut Microbiota in Chronic Heart Failure: Integration of Metagenomic Data and Metabolic Pathways in the Context of Disease Pathophysiology

Chronic Heart Failure (CHF) represents a global health concern associated with significant morbidity and mortality. Recent studies suggest a potential role of the gut microbiota in cardiac health. The objective of this investigation was to examine the associations between microbial processes in the intestine and the clinical manifestations of CHF.Methods. This prospective observational cohort study included patients over 18 years of age with a verified diagnosis of CHF. Patients were stratified based on echocardiographic data. Gut microbiome analysis was conducted using high-throughput sequencing and bioinformatic tools.The results revealed significant alterations in the composition of the intestinal microflora in patients with CHF compared to healthy controls. A reduction in alpha diversity and changes in beta diversity were observed, indicating a disruption in the microbial balance. Patients with CHF exhibited a significant decrease in the Firmicutes/Bacteroidetes ratio. At the family and genus levels, significant changes were detected, including an increase in the relative abundance of Sutterellaceae, Synergistaceae, and several opportunistic bacteria. A decrease in the relative abundance of Bifidobacteriaceae and Coriobacteriaceae, known for their potential cardioprotective properties, was observed.Conclusions. Analysis of metabolic pathways demonstrated an increase in the activity of bacteria associated with protein degradation and a decrease in the activity of bacteria involved in carbohydrate metabolism. This may lead to the formation of potentially harmful substances in the intestine. The study results open new perspectives for the diagnosis and treatment of CHF. Analysis of the intestinal bacterial composition may become an additional tool in assessing the condition of patients with CHF, and modulation of the gut microflora composition may be considered as part of a comprehensive treatment approach.Keywords: chronic heart failure, metagenomics, microbiome, metabolites.