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

Autores de INCLIVA

• Anna Mireia Mollar Fernandez

  Autor

• María Pilar Villanueva Gil

  Autor

• Arturo Carratalá Calvo

  Autor

• Francisco Mora Miguel

  Autor

• Miguel Minguez Pérez

  Autor

• Vannina Gonzalez Marrachelli

  Autor

• 

  Daniel Monleon Salvado

  Autor

• 

  David Navarro Ortega

  Autor

• 

  Juan Sanchis Fores

  Autor

• 

  Julio Nuñez Villota

  Autor

Participantes ajenos a INCLIVA

• NÚÑez E
• BayÉs-GenÍs A

Grupos y Plataformas de I+D+i

• Grupo de investigación en Cardiología Clínica

  

  Leading Researcher

  Juan Sanchis Fores

• Grupo de Investigación en Imagen Molecular y Metabolómica

  

  Leading Researcher

  Daniel Monleon Salvado

• Grupo de Investigación en Trasplante Hematopoyético

  

  Leading Researcher

  Carlos Solano Vercet

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 (H-2) 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 H-2 (AUC-H-2). 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-H-2 and AUC-CH4 were 1290 U (520-2430) and 985 U (450-2120), respectively. In multivariable analysis, AUC-H-2 (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-H-2, 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.

© 2018 Elsevier Inc. All rights reserved

Keywords

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