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J Card Fail. 2019 May;25(5):319-327. doi: 10.1016/j.cardfail.2018.10.004. Epub 2018 Oct 19.

Hydrogen- and Methane-Based Breath Testing and Outcomes in Patients With Heart Failure.

Author information

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
Digestive Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain.
4
CIBER Cardiovascular, Madrid, Spain; Cardiology Service and Heart Failure Unit, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; and Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
5
Metabolomic and Molecular Image Lab, Health Research Institute, INCLIVA, Valencia, Spain.
6
Metabolomic and Molecular Image Lab, Health Research Institute, INCLIVA, Valencia, Spain; Pathology Department, Universitat de València, Valencia, Spain.
7
Microbiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain.
8
Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
9
Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain. Electronic address: yulnunez@gmail.com.

Abstract

BACKGROUND:

Recent 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 RESULTS:

We 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.

CONCLUSIONS:

AUC-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.

KEYWORDS:

Gut; breath tests; heart failure; prognosis; small intestinal bacterial overgrowth

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