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<p>Heart failure remains a major global health challenge. Emerging evidence highlights the gut microbiome’s role in its pathogenesis and progression. This systematic review analyzed 32 studies involving 5825 patients to evaluate gut microbiota alterations and microbial metabolites in heart failure. Findings on alpha diversity were inconsistent, but beta diversity showed more agreement. A common pattern included depletion of short-chain fatty acid (SCFA)–producing bacteria and enrichment of pathogenic taxa such as <i>Escherichia</i> and <i>Shigella</i>. Heart failure patients also exhibited elevated levels of harmful metabolites like trimethylamine-N-oxide (TMAO) and phenylacetylglutamine. The dysbiotic profile was marked by increased <i>Proteobacteria</i> and decreased <i>Firmicutes</i>, linked to reduced cardioprotective metabolite production and heightened inflammation. These shifts may worsen heart failure prognosis and contribute to systemic inflammation. The results support the potential of microbiome-targeted therapies, such as probiotics, as adjunctive strategies in heart failure management.</p>

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The gut-heart axis in heart failure: a systematic review and meta-analysis of gut microbiota and metabolites

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月16日

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  • Fayez Yassine,
  • Alia Albush,
  • Aya Hanna,
  • Hassan Abbas,
  • Melhem Bilen

摘要

Heart failure remains a major global health challenge. Emerging evidence highlights the gut microbiome’s role in its pathogenesis and progression. This systematic review analyzed 32 studies involving 5825 patients to evaluate gut microbiota alterations and microbial metabolites in heart failure. Findings on alpha diversity were inconsistent, but beta diversity showed more agreement. A common pattern included depletion of short-chain fatty acid (SCFA)–producing bacteria and enrichment of pathogenic taxa such as Escherichia and Shigella. Heart failure patients also exhibited elevated levels of harmful metabolites like trimethylamine-N-oxide (TMAO) and phenylacetylglutamine. The dysbiotic profile was marked by increased Proteobacteria and decreased Firmicutes, linked to reduced cardioprotective metabolite production and heightened inflammation. These shifts may worsen heart failure prognosis and contribute to systemic inflammation. The results support the potential of microbiome-targeted therapies, such as probiotics, as adjunctive strategies in heart failure management.