Gut microbiota and heart failure — is there a connection? Literature review

Heart failure (HF) has become an immense health concern affecting almost 1—2% of the population globally. It is a complex syndrome characterized by activation of the sympathetic nervous system and the renin–angiotensin–aldosterone axis as well as endothelial dysfunction, oxidative stress, and inflammation. It is established that gut microbiota has emerged as a crucial player in cardiovascular diseases, including heart failure (HF). Recent studies have highlighted the bidirectional interaction between the gut and the heart, often referred to as the gut–heart axis. Dysbiosis, characterized by alterations in microbial composition and function, has been linked to systemic inflammation, metabolic disturbances, and impaired cardiovascular homeostasis. Patients with HF have demonstrated significant alterations in the composition of the normal gut microbiome depending on the severity of the left ventricular ejection fraction. HF may disrupt the integrity of the intestinal barrier, leading to the translocation of microbes and their metabolites, thereby enhancing the inflammatory environment.In addition, the intestinal microbiome contributing to inflammation is capable of inducing numerous pathophysiological pathways in which cytokines and various metabolites may have a serious impact not only on the prognosis but also on the progression of HF. The possibilities of dietary and exercise measures and other therapeutic approaches are based on clinical research in human and animal models. The regulation of the intestinal microflora has become a promising field of research to develop new therapeutic strategies for the treatment of HF. Understanding the mechanisms of the microbiome`s impact on the pathogenesis of cardiovascular disease could pave the way for novel diagnostic and therapeutic strategies in the management of HF. Further research is needed to establish a cause-and-effect relationship between dysbiosis and HF and to develop personalised approaches to the treatment of HF based on the determination of the intestinal microbiota.