OBJECTIVES: We evaluated morphology and function of the gut in patients with chronic heart failure (CHF). BACKGROUND: Intestinal translocation of bacterial endotoxin may contribute to the inflammatory state observed in patients with CHF. The morphology and function of the gut may be abnormal. METHODS: We studied 22 patients with CHF (age 67 +/- 2 years, left ventricular ejection fraction [LVEF] 31 +/- 1%, New York Heart Association functional class 2.3 +/- 0.1, peak VO2 15.0 +/- 1.0 ml/kg/min) and 22 control subjects (62 +/- 1 years, LVEF 68 +/- 2%, peak VO2 24.7 +/- 1.3 ml/kg/min). Bowel wall thickness was assessed by transcutaneous sonography, small intestinal permeability by the lactulose-mannitol test, passive carrier-mediated transport by D-xylose test, large intestinal permeability by sucralose test (5- and 26-h urine collection, high-performance liquid chromatography), and mucosal bacterial biofilm by fluorescence in situ hybridization in biopsies taken during sigmoidoscopy. RESULTS: Chronic heart failure patients, compared with control patients, showed increased bowel wall thickness in the terminal ileum (1.48 +/- 0.16 mm vs. 1.04 +/- 0.08 mm), ascending colon (2.32 +/- 0.18 mm vs. 1.31 +/- 0.14 mm), transverse colon (2.19 +/- 0.20 vs. 1.27 +/- 0.08 mm), descending colon (2.59 +/- 0.18 mm vs. 1.43 +/- 0.13 mm), and sigmoid (2.97 +/- 0.27 mm vs. 1.64 +/- 0.14 mm) (all p < 0.01). Chronic heart failure patients had a 35% increase of small intestinal permeability (lactulose/mannitol ratio: 0.023 +/- 0.001 vs. 0.017 +/- 0.001, p = 0.006), a 210% increase of large intestinal permeability (sucralose excretion: 0.62 +/- 0.17% vs. 0.20 +/- 0.06%, p = 0.03), and a 29% decrease of D-xylose absorption, indicating bowel ischemia (26.7 +/- 3.0% vs. 37.4 +/- 1.4%, p = 0.003). Higher concentrations of adherent bacteria were found within mucus of CHF patients compared with control subjects (p = 0.007). CONCLUSIONS: Chronic heart failure is a multisystem disorder in which intestinal morphology, permeability, and absorption are modified. Increased intestinal permeability and an augmented bacterial biofilm may contribute to the origin of both chronic inflammation and malnutrition.
OBJECTIVES: We evaluated morphology and function of the gut in patients with chronic heart failure (CHF). BACKGROUND: Intestinal translocation of bacterial endotoxin may contribute to the inflammatory state observed in patients with CHF. The morphology and function of the gut may be abnormal. METHODS: We studied 22 patients with CHF (age 67 +/- 2 years, left ventricular ejection fraction [LVEF] 31 +/- 1%, New York Heart Association functional class 2.3 +/- 0.1, peak VO2 15.0 +/- 1.0 ml/kg/min) and 22 control subjects (62 +/- 1 years, LVEF 68 +/- 2%, peak VO2 24.7 +/- 1.3 ml/kg/min). Bowel wall thickness was assessed by transcutaneous sonography, small intestinal permeability by the lactulose-mannitol test, passive carrier-mediated transport by D-xylose test, large intestinal permeability by sucralose test (5- and 26-h urine collection, high-performance liquid chromatography), and mucosal bacterial biofilm by fluorescence in situ hybridization in biopsies taken during sigmoidoscopy. RESULTS:Chronic heart failurepatients, compared with control patients, showed increased bowel wall thickness in the terminal ileum (1.48 +/- 0.16 mm vs. 1.04 +/- 0.08 mm), ascending colon (2.32 +/- 0.18 mm vs. 1.31 +/- 0.14 mm), transverse colon (2.19 +/- 0.20 vs. 1.27 +/- 0.08 mm), descending colon (2.59 +/- 0.18 mm vs. 1.43 +/- 0.13 mm), and sigmoid (2.97 +/- 0.27 mm vs. 1.64 +/- 0.14 mm) (all p < 0.01). Chronic heart failurepatients had a 35% increase of small intestinal permeability (lactulose/mannitol ratio: 0.023 +/- 0.001 vs. 0.017 +/- 0.001, p = 0.006), a 210% increase of large intestinal permeability (sucralose excretion: 0.62 +/- 0.17% vs. 0.20 +/- 0.06%, p = 0.03), and a 29% decrease of D-xylose absorption, indicating bowel ischemia (26.7 +/- 3.0% vs. 37.4 +/- 1.4%, p = 0.003). Higher concentrations of adherent bacteria were found within mucus of CHFpatients compared with control subjects (p = 0.007). CONCLUSIONS:Chronic heart failure is a multisystem disorder in which intestinal morphology, permeability, and absorption are modified. Increased intestinal permeability and an augmented bacterial biofilm may contribute to the origin of both chronic inflammation and malnutrition.
Authors: Paolo Marzullo; Laura Di Renzo; Gabriella Pugliese; Martina De Siena; Luigi Barrea; Giovanna Muscogiuri; Annamaria Colao; Silvia Savastano Journal: Int J Obes Suppl Date: 2020-07-20
Authors: Tetz C Lee; Min Qian; Gregory Y H Lip; Marco R Di Tullio; Susan Graham; Douglas L Mann; Koki Nakanishi; John R Teerlink; Ronald S Freudenberger; Ralph L Sacco; J P Mohr; Arthur J Labovitz; Piotr Ponikowski; Dirk J Lok; Conrado Estol; Stefan D Anker; Patrick M Pullicino; Richard Buchsbaum; Bruce Levin; John L P Thompson; Shunichi Homma; Siqin Ye Journal: Am J Cardiol Date: 2018-06-04 Impact factor: 2.778
Authors: Roy T M Sprooten; Kaatje Lenaerts; Dionne C W Braeken; Ilvy Grimbergen; Erica P Rutten; Emiel F M Wouters; Gernot G U Rohde Journal: Respiration Date: 2018-01-25 Impact factor: 3.580
Authors: Veli-Pekka Harjola; Wilfried Mullens; Marek Banaszewski; Johann Bauersachs; Hans-Peter Brunner-La Rocca; Ovidiu Chioncel; Sean P Collins; Wolfram Doehner; Gerasimos S Filippatos; Andreas J Flammer; Valentin Fuhrmann; Mitja Lainscak; Johan Lassus; Matthieu Legrand; Josep Masip; Christian Mueller; Zoltán Papp; John Parissis; Elke Platz; Alain Rudiger; Frank Ruschitzka; Andreas Schäfer; Petar M Seferovic; Hadi Skouri; Mehmet Birhan Yilmaz; Alexandre Mebazaa Journal: Eur J Heart Fail Date: 2017-05-30 Impact factor: 15.534