Pathogenic Gut Flora in Patients With Chronic Heart Failure

OBJECTIVES The goal of this study was to measure the presence of pathogenic gut flora and intestinal permeability (IP) and their correlations with disease severity, venous blood congestion, and inflammation in patients with chronic heart failure (CHF). BACKGROUND Evidence suggests that translocation of gut flora and/or their toxins from the intestine to the bloodstream is a possible trigger of systemic CHF inflammation. However, the relation between pathogenic gut flora and CHF severity, as well as IP, venous blood congestion as right atrial pressure (RAP), and/or systemic inflammation (C-reactive protein [CRP]), is still unknown. METHODS This study analyzed 60 well-nourished patients in stable condition with mild CHF (New York Heart Association [NYHA] functional class I to II; n = 30) and moderate to severe CHF (NYHA functional class III to IV; n = 30) and matched healthy control subjects (n = 20). In all subjects, the presence and development in the feces of bacteria and fungi (Candida species) were measured; IP according to cellobiose sugar test results was documented. The study data were then correlated with RAP (echocardiography) and systemic inflammation. RESULTS Compared with normal control subjects, the entire CHF population had massive quantities of pathogenic bacteria and Candida such as Campylobacter (85.3 +/- 3.7 CFU/ml vs. 1.0 +/- 0.3 CFU/ml; p < 0.001), Shigella (38.9 +/- 12.3 CFU/ml vs. 1.6 +/- 0.2 CFU/ml; p < 0.001), Salmonella (31.3 +/- 9.1 CFU/ml vs 0 CFU/ml; p < 0.001), Yersinia enterocolitica (22.9 +/- 6.3 CFU/ml. vs. 0 CFU/ml; p < 0.0001), and Candida species (21.3 +/- 1.6 CFU/ml vs. 0.8 +/- 0.4 CFU/ml; p < 0.001); altered IP (10.2 +/- 1.2 mg vs. 1.5 +/- 0.8 mg; p < 0.001); and increased RAP (12.6 +/- 0.6 mm Hg) and inflammation (12.5 +/- 0.6 mg/dl). These variables were more pronounced in patients with moderate to severe NYHA functional classes than in patients with the mild NYHA functional class. Notably, IP, RAP, and CRP were mutually interrelated (IP vs. RAP, r = 0.55; p < 0.0001; IP vs. CRP, r = 0.78; p < 0.0001; and RAP vs. CRP, r = 0.78; p < 0.0001). CONCLUSIONS This study showed that patients with CHF may have intestinal overgrowth of pathogenic bacteria and Candida species and increased IP associated with clinical disease severity, venous blood congestion, and inflammation. (J Am Coll Cardiol HF 2016;4:220-7) (C) 2016 by the American College of Cardiology Foundation.