Abstract
In patients with heart failure (HF), the exhaled concentrations of hydrogen after a breath test—a non-invasive assessment of small intestinal overgrowth- has been related to HF severity and higher risk of adverse outcomes. Indeed, two intestinal bacterial metabolites—blood Trimethylamine N-Oxide (TMAO) and butyrate—have been related to a worse prognosis in HF. However, the relationship between the exhaled concentrations of hydrogen after a breath test and these two metabolites remains unknown. Thus, in this post-hoc analysis, we sought to evaluate whether these two metabolites are associated with the exhaled concentrations of hydrogen after a breath test in patients with a recent admission for HF. We included 60 patients with a recent hospitalization for HF. Cumulative hydrogen over time was integrated into a single measurement by the area under the concentration curve (AUC-H2). A linear regression multivariable analysis was used to evaluate the associations. A 2-sided p-value < 0.05 was considered to be statistically significant. The median (p25–p75) amino-terminal pro-brain natriuretic peptide, AUC-H2, TMAO, and Butyrate were 4789 pg/ml (1956–11149), 1615 (700–2585), 0.68 (0.42–1.12), and 0.22 ± 13, respectively. After multivariate adjustment, TMAO and butyrate were significantly associated with AUC-H2 (p = 0.027 and p = 0.009, respectively). For TMAO, this association was positive and for butyrate, negative. Bacterial-origin metabolites TMAO and Butyrate were independently related to AUC-H2 in patients with a recent hospitalization for acute HF.
Highlights
In patients with heart failure (HF), the exhaled concentrations of hydrogen after a breath test—a non-invasive assessment of small intestinal overgrowth- has been related to HF severity and higher risk of adverse outcomes
HF has been linked to intestinal bacterial overgrowth, low bacterial richness, increased intestinal permeability, dysbiosis, and the presence of bacterial metabolites in the b loodstream[1,2,3]
We found that the exhaled concentration of hydrogen after a lactulose breath test—a surrogate of small intestinal overgrowth (SIBO)—was associated with greater inflammatory activity, HF severity, and a higher risk of adverse outcomes in 102 patients with HF5
Summary
In patients with heart failure (HF), the exhaled concentrations of hydrogen after a breath test—a non-invasive assessment of small intestinal overgrowth- has been related to HF severity and higher risk of adverse outcomes. We found that the exhaled concentration of hydrogen after a lactulose breath test—a surrogate of small intestinal overgrowth (SIBO)—was associated with greater inflammatory activity, HF severity, and a higher risk of adverse outcomes in 102 patients with HF5. Aiming to evaluate whether TMAO and butyrate share a common pathophysiological link with SIBO, in this post-hoc analysis, we sought to evaluate whether serum samples of TMAO and butyrate are associated with the exhaled concentration of hydrogen after a lactulose test in a cohort of patients with a recent HF decompensation
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