Gut microbiome dysbiosis in heart failure: Updated evidence, mechanisms, and therapeutic directions.

Abstract

<h4>Background</h4>Emerging evidence suggests a significant link between the gut microbiome and cardiovascular health, yet its role in the pathophysiology of heart failure has been underexplored. This systematic review and meta-analysis synthesize available research on how gut microbiota influence heart failure, offering new insights into therapeutic interventions.<h4>Methods</h4>We conducted a comprehensive search of multiple databases for studies published up to the present, focusing on observational and experimental research that examines the relationship between the gut microbiome and heart failure outcomes. Eligibility criteria included studies on humans with diagnosed heart failure, assessments of microbiome composition, and reported cardiovascular outcomes. Quality assessment was performed using standardized tools, and meta-analysis was conducted to quantify the impact of microbiome diversity and composition on heart failure progression and response to treatment.<h4>Results</h4>The analysis included 25 studies encompassing 3200 patients with heart failure. Specific microbial profiles, particularly an increased abundance of <i>Firmicutes</i> and decreased <i>Bacteroidetes</i>, were associated with worsened heart failure conditions. Correlations were found between microbial diversity indices and clinical markers such as left ventricular ejection fraction (LVEF) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels. Mechanistic insights suggested that microbial metabolites, such as short-chain fatty acids and trimethylamine-N-oxide (TMAO), play a critical role in modulating inflammatory pathways and cardiac function.<h4>Conclusions</h4>This review highlights the gut microbiome as a potential target for innovative therapeutic strategies in heart failure management. Modulating gut microbiota composition and diversity through dietary interventions, probiotics, or microbiome transplantation could offer new avenues for improving cardiovascular outcomes in heart failure patients. Integrative approaches in cardiovascular healthcare should consider the gut-heart axis for comprehensive disease management.