Integrative analysis of the gut-liver-heart axis in coronary artery disease: From chronic metabolic dysbiosis to acute cardiogenic shock

The complex interplay between chronic metabolic disorders and acute cardiovascular decompensation represents a critical frontier in cardiology. This integrative research program conducted at Chongqing Medical University systematically examines the gut-liver-heart axis across the cardiovascular disease spectrum through three interconnected studies. First, a case-control investigation of coronary artery disease (CAD) patients with and without nonalcoholic fatty liver disease (NAFLD) revealed distinct intestinal dysbiosis patterns characterized by increased Coprococcus and Veillonella alongside decreased Parabacteroides, Bacteroides fragilis, and Bifidobacterium longum, with these microbial alterations correlating significantly with body mass index, triglyceride levels, and hepatic transaminases. Second, a retrospective cohort study of acute myocardial infarction complicated by cardiogenic shock demonstrated that elevated admission bilirubin (HR = 1.020, P = 0.003) and alanine aminotransferase independently predicted 30-day mortality, while serum albumin exerted protective effects (HR = 0.955, P < 0.001). Third, analysis of a comprehensive clinical registry illuminated the systemic clustering of metabolic, renal, and inflammatory abnormalities that underpin both chronic cardiometabolic disease and acute cardiovascular collapse. Collectively, these findings establish a pathogenic continuum wherein chronic intestinal dysbiosis and subclinical hepatic dysfunction create a vulnerable substrate that amplifies injury during acute ischemic events. This research framework provides mechanistic insights into the gut-liver-heart axis and proposes integrated biomarker panels for risk stratification across cardiovascular disease stages.