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European Journal of Heart Failure 2007 9(6-7):574-578; doi:10.1016/j.ejheart.2007.02.005
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© 2007 European Society of Cardiology

Intestinal paracellular permeability is not affected in chronic congestive heart failure

M. Schaufelbergera,*, I. Ekmanb, E. Björnssonc, E. Kalaitzakisc and T. Ekmand

a Department of Internal Medicine, Sahlgrenska University Hospital, Östra, 416 85 Gothenburg, Sweden
b Institute of Health and Care Sciences, The Sahlgrenska Academy at Göteborg University, Göteborg, Sweden
c Department of Internal Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
d Department of Internal Medicine and Oncology, Sahlgrenska University Hospital, Göteborg, Sweden

* Corresponding author. Tel: +46 31 3434000; fax: +46 31 259254. E-mail address: maria.schaufelberger{at}hjl.gu.se


  Abstract

Background: In chronic heart failure (CHF) it has been proposed that a dysfunction of the gastrointestinal barrier could lead to translocation of endotoxin into the systemic circulation. A secondary inflammatory reaction, observed as increased levels of cytokines, could negatively affect cardiac function. The aims of this paper were therefore to determine whether patients with CHF have a disturbed mucosal barrier and whether it was possible to detect endotoxin in venous blood.

Methods: Nineteen stable patients with CHF (New York Heart Association II–III, EF≤40% or EF>40% and earlier hospitalisation for heart failure) were investigated. Twenty healthy subjects (HS group) and 25 patients, who were admitted for bone marrow transplantation (BMT group), served as controls. Gastrointestinal permeability was assessed by a 51Cr-EDTA absorption test.

Results: Eleven patients with and eight without peripheral oedema were included. Median age was 76.5 years. Intestinal permeability was 1.82±1.96% in the CHF patients and 1.54±.59% and 1.9±.9% in HS and BMT groups, respectively (p=0.4 and p=0.7, CHF vs HS and BMT, respectively). No difference was found between patients with and without oedema and endotoxins were below the detection limit in all patients.

Discussion: This study does not support the hypothesis that patients with CHF have a dysfunctional gastrointestinal barrier, at least as assessed by the 51Cr-EDTA resorbtion test.

Key Words: Heart failure • Intestinal permeability • Endotoxin1

Received November 16, 2006; Revised December 14, 2006; Accepted February 1, 2007


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