Chen An-Tian, Zhang Jian, Zhang Yuhui
Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases Beijing China.
State Key Laboratory of Cardiovascular Disease, Heart Failure Center, Fuwai Hospital Chinese Academy of Medical Sciences & Peking Union Medical College/National Center for Cardiovascular Diseases Beijing China.
Imeta. 2023 Jul 10;2(3):e125. doi: 10.1002/imt2.125. eCollection 2023 Aug.
Heart failure (HF) is a sophisticated syndrome with structural or functional impairment of ventricular filling or ejection of blood, either causing symptoms and signs or being asymptomatic. HF is a major global health issue affecting about 64.3 million people worldwide. The gut microbiota refers to the complex ecosystem of microorganisms, mainly bacteria, in the gut. Studies have revealed that the gut microbiota is associated with many diseases ranging from neurodegenerative diseases to inflammatory bowel disease and cardiovascular diseases. The gut hypothesis of HF suggests that low cardiac output and systemic circulation congestion would cause insufficient intestinal perfusion, leading to ischemia and intestinal barrier dysfunction. The resulting bacterial translocation would contribute to inflammation. Recent studies have refined the hypothesis that changes of metabolites in the gut microbiota have a close relationship with HF. Thus, the gut microbiota has emerged as a potential therapeutic target for HF due to both its critical role in regulating host physiology and metabolism and its pivotal role in the development of HF. This review article aims to provide an overview of the current understanding of the gut microbiota's involvement in HF, including the introduction of the gut hypothesis of HF, its association with HF progression, the potential mechanisms involved mediated by the gut microbiota metabolites, and the impact of various interventions on the gut microbiota, including dietary interventions, probiotic therapy, fecal microbiota transplantation, antibiotics, and so on. While the gut hypothesis of HF is refined with up-to-date knowledge and the gut microbiota presents a promising target for HF therapy, further research is still needed to further understand the underlying mechanisms between gut microbiota and HF, the efficacy of these interventions, and contribute to the health of HF patients.
心力衰竭（HF）是一种复杂的综合征，伴有心室充盈或射血的结构或功能损害，可导致症状和体征，也可能无症状。HF是一个重大的全球健康问题，全球约有6430万人受其影响。肠道微生物群是指肠道内微生物的复杂生态系统，主要是细菌。研究表明，肠道微生物群与从神经退行性疾病到炎症性肠病和心血管疾病等多种疾病有关。HF的肠道假说认为，低心输出量和体循环充血会导致肠道灌注不足，进而导致缺血和肠屏障功能障碍。由此产生的细菌易位会促进炎症反应。最近的研究完善了这一假说，即肠道微生物群中代谢产物的变化与HF密切相关。因此，由于肠道微生物群在调节宿主生理和代谢方面的关键作用以及在HF发生发展中的核心作用，它已成为HF潜在的治疗靶点。这篇综述文章旨在概述目前对肠道微生物群参与HF的理解，包括介绍HF的肠道假说、其与HF进展的关联、肠道微生物群代谢产物介导的潜在机制，以及各种干预措施对肠道微生物群的影响，包括饮食干预、益生菌治疗、粪便微生物群移植、抗生素等等。虽然HF的肠道假说随着最新知识得到了完善，且肠道微生物群是HF治疗的一个有前景的靶点，但仍需要进一步研究，以进一步了解肠道微生物群与HF之间的潜在机制、这些干预措施的疗效，并为HF患者的健康做出贡献。
