Plasma zonulin correlates with cardiac dysfunction and poor physical performance in patients with chronic heart...

An aberrant intestinal permeability is often associated with systemic inflammation and cardiovascular diseases accompanied by compromised physical performance. However, the link between these complications is poorly defined. Here we investigated the potential association of zonulin, a regulator of intestinal permeability, with ischemic and non-ischemic heart failure (HF) and, associated physical disability.

The investigation including echocardiography, short physical performance battery (SPPB) and measurement of plasma zonulin and c-reactive protein (CRP), was performed in 59 HF patients and an equal number of healthy controls.

As expected, the left ventricular end-systolic dimension (LVESD) was significantly higher, which was accompanied by a significantly lower LV ejection fraction (EF) in the HF patients compared to controls. The levels of plasma zonulin and CRP was profoundly elevated in both ischemic (P < 0.0001) and non-ischemic (P < 0.01) HF patients. Interestingly, LVESD positively (r² = 0.156, P = 0.001) and LVEF negatively (r² = 0.186, P = 0.0006) correlated with the level of zonulin in HF patients. The SPPB scores for balance, chair sit-to-stand (STS), gait speed (GS), and hand grip strength (HGS) were consistently compromised in HF patients. Moreover, LVESD was negatively (r² = 0.118, P = 0.007), and there was trend of positive correlation of LVEF (r² = 0.05, P = 0.08) with the SPPB scores for balance. Consistently, zonulin levels was negatively correlated with SPPB scores for balance (r² = 0.176, P = 0.0009), STS (r² = 0.120, P = 0.001) and HGS (r² = 0.085, P = 0.02).

Chronic cardiac complications induce the level of plasma zonulin, which predicts the cardiac remodeling and dysfunction and physical performance in patients with chronic HF.