Hydrogen- and Methane-Based Breath Testing and Outcomes in Patients With Heart Failure |
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Authors: | Anna Mollar Maria Pilar Villanueva Eduardo NÚÑez Arturo CarratalÁ Francisco Mora Antoni BayÉs-GenÍs Miguel MÍnguez Vannina G Marrachelli Daniel Monleon David Navarro Juan Sanchis Julio NÚÑez |
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Institution: | 1. Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain;2. Servicio de Bioquímica Clínica, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain;3. CIBER Cardiovascular, Madrid, Spain;4. Digestive Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain;5. Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; and Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain;6. Metabolomic and Molecular Image Lab, Health Research Institute, INCLIVA, Valencia, Spain;7. Pathology Department, Universitat de València, Valencia, Spain;8. Microbiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain |
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Abstract: | BackgroundRecent evidence endorses gut microbiota dysregulation in the pathophysiology of heart failure (HF). Small intestinal bacterial overgrowth (SIBO) might be present in HF and associated with poor clinical outcomes. Lactulose breath testing is a simple noninvasive test that has been advocated as a reliable indicator of SIBO. In patients with HF, we aimed to evaluate the association with clinical outcomes of the exhaled hydrogen (H2) and methane (CH4) concentrations through the lactulose breath test.Methods and ResultsWe included 102 patients with HF in which lactulose SIBO breath tests were assessed. Cumulative gas was quantified by the area under the receiver operating characteristic curve of CH4 (AUC-CH4) and H2 (AUC-H2). Clinical end points included the composite of all-cause death with either all-cause or HF hospitalizations, recurrent all-cause hospitalizations, and recurrent HF hospitalizations. Medians (interquartile ranges) of AUC-H2 and AUC-CH4 were 1290 U (520-2430) and 985 U (450-2120), respectively. In multivariable analysis, AUC-H2 (per 1000 U) was associated with all-cause death/all-cause hospitalization (hazard ratio HR] 1.21, 95% CI 1.04–1.40; P = .012), all-cause death/HF hospitalization (HR 1.20, 95% CI 1.03–1.40; P = .021), and an increase in the rate of recurrent all-cause (incidence rate ratio IRR] 1.31, 95% CI 1.14–1.51; P < .001) and HF (IRR 1.41, 95% CI 1.15–1.72; P = .001) hospitalizations. AUC-CH4 was not associated with any of these end points.ConclusionsAUC-H2, a safe and noninvasive method for SIBO estimation, is associated with higher risk of long-term adverse clinical events in patients with HF. In contrast, AUC-CH4 did not show any prognostic value. |
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Keywords: | Reprint requests: Julio Núñez MD PhD FHFA Cardiology Department Hospital Clínico Universitario Avda Blasco Ibáñez 17 46010 Valencia Spain Tel: +34652856689 Fax: +34963862658 Gut heart failure small intestinal bacterial overgrowth breath tests prognosis |
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