The Gut in Heart Failure: Current Knowledge and Novel Frontiers

Area of Science:

• Cardiology
• Gastroenterology
• Microbiology

Background:

• Heart failure (HF) is a global health issue with unmet therapeutic needs.
• The gastrointestinal system's role in HF is increasingly recognized.
• Existing HF treatments have limitations, necessitating novel strategies.

Purpose of the Study:

• To review the complex interplay between the gastrointestinal system and heart failure.
• To explore the gut-heart axis as a basis for novel therapeutic approaches in HF.
• To highlight the relevance of microbiota modulation and cotransporter inhibition in HF.

Main Methods:

• Literature review of recent data on the gut-heart axis in HF.
• Analysis of mechanisms linking gastrointestinal changes to HF progression.
• Discussion of therapeutic strategies targeting the gut microbiota and cotransporters.

Main Results:

• Hemodynamic changes in HF affect gut morphology, permeability, and function.
• Alterations in gut microbiota composition contribute to HF mechanisms via bacterial translocation and metabolic pathways.
• Upregulation of NHE3 cotransporters exacerbates salt and fluid overload in HF.

Conclusions:

• The gut-heart axis is a critical factor in HF pathophysiology.
• Modulating gut microbiota (diet, probiotics, fecal transplantation) shows therapeutic potential.
• Inhibitors of cotransporters like NHE3 represent a promising new frontier for HF treatment.