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Mollar A, Villanueva MP, NÚÑez E, CarratalÁ A, Mora F, BayÉs-GenÍs A, MÍnguez M, Marrachelli VG, Monleon D, Navarro D, Sanchis J, NÚÑez J. Hydrogen- and Methane-Based Breath Testing and Outcomes in Patients With Heart Failure. J Card Fail 2018; 25:319-327. [PMID: 30347272 DOI: 10.1016/j.cardfail.2018.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 09/19/2018] [Accepted: 10/12/2018] [Indexed: 12/17/2022]
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.
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Affiliation(s)
- Anna Mollar
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Maria Pilar Villanueva
- Servicio de Bioquímica Clínica, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Eduardo NÚÑez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Arturo CarratalÁ
- Servicio de Bioquímica Clínica, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Valencia, Spain
| | - Francisco Mora
- Digestive Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Antoni BayÉs-GenÍs
- 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
| | - Miguel MÍnguez
- Digestive Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Vannina G Marrachelli
- Metabolomic and Molecular Image Lab, Health Research Institute, INCLIVA, Valencia, Spain
| | - Daniel Monleon
- Metabolomic and Molecular Image Lab, Health Research Institute, INCLIVA, Valencia, Spain; Pathology Department, Universitat de València, Valencia, Spain
| | - David Navarro
- Microbiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Juan Sanchis
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain
| | - Julio NÚÑez
- Cardiology Department, Hospital Clínico Universitario, INCLIVA, Universitat de València, Valencia, Spain; CIBER Cardiovascular, Madrid, Spain.
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