Gut Failure: A Review of the Pathophysiology and Therapeutic Potentials in the Gut-Heart Axis

Despite considerable advances in the field, heart failure (HF) still poses a significant disease burden among affected individuals since it continues to cause high morbidity and mortality rates. Inflammation is considered to play a key role in disease progression, but the exact underlying pathophysiological mechanisms involved have not yet been fully elucidated. The gut, as a potential source of inflammation, could feasibly explain the state of low-grade inflammation seen in patients with chronic HF. Several derangements in the composition of the microbiota population, coupled with an imbalance between favorable and harmful metabolites and followed by gut barrier disruption and eventually bacterial translocation, could contribute to cardiac dysfunction and aggravate HF. On the other hand, HF-associated congestion and hypoperfusion alters intestinal function, thereby creating a vicious cycle. Based on this evidence, novel pharmaceutical agents have been developed and their potential therapeutic use has been tested in both animal and human subjects. The ultimate goal in these efforts is to reverse the aforementioned intestinal derangements and block the inflammation cascade. This review summarizes the gut-related causative pathways implicated in HF pathophysiology, as well as the associated therapeutic interventions described in the literature.

Automated summary

Despite advances in the field, heart failure remains a significant burden due to its high morbidity and mortality rates. The role of inflammation in disease progression is not fully understood, but the gut has been implicated as a potential source of inflammation in patients with chronic heart failure. Changes in the composition of the gut microbiota, disruption of the gut barrier, and bacterial translocation could contribute to cardiac dysfunction and worsen heart failure. on the other hand, heart failure can also affect intestinal function, creating a vicious cycle. New pharmaceutical agents have been developed to reverse these intestinal changes and block inflammation cascade, with the goal of treating heart failure. This review summarizes the gut-related pathways and therapeutic interventions in heart failure.