The role of the gut microbiota and metabolites in heart failure and possible implications for treatment.

The prevalence of heart failure has increased significantly in recent years, prompting investigations into novel contributory factors. Among these, alterations in the gut microbiota composition have garnered attention due to their potential association with heart failure. Disruption in the bacterial environment associated with heart failure is characterized by heightened levels of Proteobacteria and Firmicutes and decreased levels of Bifidobacteria and Bacteroides. Reduced blood supply weakens the gut barrier, facilitating the transportation of bacteria and metabolites into the bloodstream. This breach can trigger an immune response and inflammation, subsequently contributing to the pathogenesis of heart failure through the generation of harmful organic compounds in the gastrointestinal tract and bloodstream. Specific metabolites, including short-chain fatty acids, trimethylamine, and trimethylamine N-oxide also contribute to the development of heart failure. Management of heart failure includes pharmacological management, surgery, and lifestyle modifications including recommendations for the consumption of a diet high in fruits and low in animal products. Heart failure can be managed by modulating the gut microbiota. Clinical interventions include antibiotics, prebiotics, and dietary changes. However, other approaches including fecal microbial transplantation, probiotics, and natural phytochemicals are still under study in animal models. This review highlights the significant yet underexplored link between gut microbiota and heart failure, suggesting that further research could lead to new therapeutic strategies and dietary recommendations to mitigate heart failure progression.