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Intestinal permeability evaluation in patients with chronic Chagas heart failure
Angela Braga Rodrigues1, Henrique Oswaldo da Gama Torres2, Maria do Carmo Pereira Nunes1,2
1Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.
Insights
This study found no significant difference in intestinal permeability between chronic Chagas cardiomyopathy patients and healthy controls. Further research is needed for patients with more severe left ventricular ejection fraction (LVEF) reductions.
Area of Science:
- Cardiology
- Gastroenterology
- Infectious Diseases
Background:
- Intestinal dysfunction may worsen chronic Chagas cardiomyopathy (CCC) outcomes.
- Understanding gut barrier function is crucial for managing heart failure in CCC patients.
Purpose of the Study:
- To analyze intestinal permeability in CCC patients.
- To assess the association between intestinal permeability and clinical factors, echocardiographic parameters, and disease prognosis.
- To compare intestinal permeability between CCC patients and healthy controls.
Main Methods:
- Prospective selection of 50 CCC patients with left ventricular ejection fraction (LVEF) <55% and 27 healthy controls.
- Intestinal permeability assessed using the lactulose/mannitol sugar probe drink test.
- Urinary recovery of mannitol (monosaccharide) and lactulose (disaccharide) measured over a follow-up period of 18 ± 8 months.
Main Results:
- No significant difference in the lactulose/mannitol ratio was observed between CCC patients and healthy controls.
- Intestinal permeability did not correlate with clinical signs of congestion, hemodynamic parameters, or disease severity and outcome.
Conclusions:
- The study did not detect intestinal barrier disturbances in CCC patients with LVEF <55% via lactulose/mannitol ratio.
- Further investigation is warranted to determine if intestinal permeability increases in patients with LVEF <40%.
Aims:
We analysed intestinal permeability in patients with chronic Chagas cardiomyopathy (CCC) and evaluated its association with clinical manifestations, haemodynamic parameters measured by echocardiogram, and disease outcome. Intestinal permeability was compared between CCC patients and a group of healthy controls.
Background:
Intestinal dysfunction may contribute to a more severe disease presentation with worse outcome in patients with CCC and heart failure.
Methods:
Fifty patients with CCC and left ventricular ejection fraction (LVEF) of less than 55% were prospectively selected and followed for a mean period of 18 ± 8 months. A group of 27 healthy volunteers were also investigated. One patient was excluded from the analysis since he died before completing the intestinal permeability test. Intestinal permeability was evaluated with the sugar probe drink test. It consists in the urinary recovery of previously ingested sugar probes: mannitol, a monosaccharide, and lactulose, a disaccharide.
Results:
Patient's mean age was 53.4 ± 10.4 years, and 31(63%) were male. Differential urinary excretion of lactulose/mannitol ratio did not differ significantly between healthy controls and CCC patients, regardless of clinical signs of venous congestion, haemodynamic parameters, and severity of presentation and outcome.
Conclusions:
The present study could not show a disturbance of the intestinal barrier in CCC patients with LVEF <55%, measured by lactulose/mannitol urinary excretion ratio. Further investigations are needed to verify if in patients with LVEF <40% intestinal permeability is increased.
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