Gut Microbial Metabolism in Heart Failure

Despite significant advances in drug development and therapeutic strategies, heart failure (HF) continues to have a high burden of morbidity and mortality. Current treatment options for advanced HF are limited to cardiac replacement therapies such as heart transplantation and left ventricular assist devices, but even these therapies pose restrictions of related complications and high rehospitalization rates. There remains a strong need for novel insight into the pathophysiology of HF to develop more precise, personalized, and complementary therapeutics. Recent evidence has demonstrated that alterations in the gut microbiome could play a role in HF progression and development. Changes in gut microbiota composition and metabolism, or gut dysbiosis, has been linked to HF’s pathogenic disease outcomes. While understanding of the specific mechanisms behind HF-related gut dysbiosis is limited, research has illustrated the effects of several gut microbial metabolites such as short-chain fatty acids, bile acids, trimethylamine N-oxide, amino acid metabolites, and phenylacetylglutamine and their implications in HF pathogenesis and overall cardiac health. The use of gut microbial metabolites as diagnostic biomarkers and therapeutic targets for HF demonstrates great clinical potential. Further insight into the complex gut microbiome–host interactions opens the door to improved treatment options and more comprehensive and personalized HF care.