Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, 9500 Euclid Avenue, Desk J3-4, Cleveland, OH, 44195, USA.
Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Curr Heart Fail Rep. 2021 Apr;18(2):23-32. doi: 10.1007/s11897-021-00503-4. Epub 2021 Feb 9.
Over the past decade, the gut microbiome has been shown to play an important role in the pathogenesis of heart failure (HF) and serves as a mediator that links host genomes and environmental exposure (especially dietary intake) to the development and progression of HF. Given that alterations in gut microbial composition and metabolism are commonly seen in patients with HF, the use of gut microbial metabolites as diagnostic and prognostic biomarkers, as well as novel therapeutic targets for HF, is promising.
Alterations in gut microbial composition and function have bidirectional relationships with HF. Gut microbial metabolites, including short-chain fatty acids, bile acids, trimethylamine N-oxide (TMAO), and amino acid metabolites, have been shown to play a significant role in HF. For example, TMAO has been consistently demonstrated as an independent predictor of worse prognosis in patients with HF, and a potential therapeutic target for cardiac remodeling and HF. However, clinical studies on dietary interventions targeting gut microbial metabolites have demonstrated inconsistent findings, which could be from variations in the study population, gut microbial communities, and study designs. Measurement of gut microbial metabolites can improve risk stratification and potentially identify HF patients who are more likely to respond to personalized pharmacologic or dietary interventions targeting specific pathways associated with the gut microbiome.
在过去的十年中，肠道微生物群被证明在心力衰竭（HF）的发病机制中起着重要作用，并且作为一种介质，将宿主基因组和环境暴露（特别是饮食摄入）与 HF 的发生和进展联系起来。鉴于 HF 患者的肠道微生物组成和代谢通常会发生改变，因此使用肠道微生物代谢物作为 HF 的诊断和预后生物标志物以及新的治疗靶点是有前途的。
肠道微生物组成和功能的改变与 HF 呈双向关系。肠道微生物代谢物，包括短链脂肪酸、胆汁酸、三甲胺 N-氧化物（TMAO）和氨基酸代谢物，已被证明在 HF 中发挥重要作用。例如，TMAO 一直被证明是 HF 患者预后不良的独立预测因子，也是心脏重构和 HF 的潜在治疗靶点。然而，针对肠道微生物代谢物的饮食干预的临床研究得出了不一致的结果，这可能是由于研究人群、肠道微生物群落和研究设计的差异所致。肠道微生物代谢物的测量可以改善风险分层，并可能识别出更有可能对针对肠道微生物组相关特定途径的个性化药物或饮食干预措施有反应的 HF 患者。
