Pathogenic Gut Flora Linked to Disease Severity in Chronic Heart Failure Patients

A possible link has been found between pathogenic gut flora and severity of chronic heart failure deterioration and venous blood congestion.

In addition to demonstrating altered intestinal permeability (IP), patients with chronic heart failure (CHF) also experienced intestinal overgrowth of pathogenic bacteria in a recent study published in JACC: Heart Failure. These variables became more pronounced as the disease severity increased, researchers reported.

The aim of the study was to evaluate the presence of pathogenic gut flora and IP, and to determine their relationship with disease severity, venous blood congestion, and inflammation in patients with CHF.

Sixty well-nourished and stable patients with either mild (New York Heart Association [NYHA] class, I-II; n=30) or moderate-to-severe (NYHA class, III-IV; n=30) CHF were enrolled in the study, and matched with 20 healthy controls.

Researchers tested for the presence and development of bacteria and fungi in feces, and performed a cellobiose sugar test to determine patients’ intestinal permeability (IP).

Compared with controls, patients with CHF had larger quantities of pathogenic bacteria and Candida (expressed as colony forming units/mL), including Campylobacter (85.3 ± 3.7 vs 1 ± 0.3), Shigella (38.9 ± 12.3 vs 1.6 ± 0.2), Salmonella (31.3 ± 9.1 vs. 0), Yersinia enterocolitica (22.9 ± 6.3 vs 0), and Candida species (21.3 ± 1.6 vs 0.8 ± 0.4; P for all <.001).

Additional results indicated that patients with CHF compared with controls also had altered intestinal permeability (10.2 ± 1.2 mg vs 1.5 ± 0.8 mg; P<.001), and increased right atrial pressure (RAP; 12.6 ± 0.6 mm Hg) and inflammation (12.5 ± 0.6 mg/dL).

These discrepancies were more pronounced in patients with moderate-to-severe vs mild CHF.

The findings also suggested that IP, RAP and C-reactive protein (CRP) were mutually interrelated: IP vs RAP, r=0.55; IP vs CRP, r=0.78; RAP vs CRP, r=0.78 (P for all <.0001).

“Gut pathogenic bacteria alerted [IP] with inflammation and RAP, [and] were associated with clinical disease severity in patients with stable [CHF],” the researchers wrote. “This simple, repeatable and non-invasive technique could provide important clinical information to treat complicated multi-organ syndromes such as CHF.”

For the future, the researchers noted that studies are necessary to confirm the association between gut pathogenic bacteria and CHF severity.

“If confirmed, this link could suggest additional personalized [therapeutic] strategies for CHF patients in support of traditional drugs,” they wrote.


Pasini E, Aquilani R, Testa C, et al. Pathogenic gut flora in patients with chronic heart failure. JACC Heart Fail. 2015. doi:10.1016/j.jchf.2015.10.009.