Heart failure & cardiomyopathies
Gut microbiome-derived metabolites as prognostic biomarkers in heart failure: a systematic review and meta-analysis
Authors' conclusion
Elevated TMAO and PAGln are consistently associated with adverse outcomes across diverse HF cohorts
Study context
- Population
- Patients with heart failure (HF)
- Participants
- 17,715 patients · 20 studies
- Comparison
- Elevated vs lower gut microbial metabolites
- Outcome
- All-cause mortality
- Follow-up
- Median 31.7 months
Methodological detailspreregistered, random-effects
- Preregistered
- Random-effects
Pooled result
As reported in the abstract
Hazard ratio (95% CI)P value
Elevated TMAOI2 37.3%
1.72(1.42–2.08)
P = 0.0002Elevated PAGlnI2 0%
1.60(1.33–1.94)
P < 0.0001Further pooled results
All-cause mortality with elevated TMAO, by HF phenotype (subgroup)
| Comparison | HR (95% CI) | |
|---|---|---|
| Elevated TMAOHFrEF; I2 0% | 2.17 (1.68–2.81) | |
| Elevated TMAOHFpEF; I2 0% | 1.55 (0.92–2.61) | |
| 0.20.5125Hazard ratio (log scale) |
Major adverse cardiac events (MACE)
| Comparison | HR (95% CI) | P value | |
|---|---|---|---|
| Higher TMAOI2 0% | 1.60 (1.44–1.78) | P < 0.0001 | |
| Elevated PAGlnI2 2.1% | 1.65 (1.37–1.99) | P < 0.0001 | |
| 0.512Hazard ratio (log scale) |
MACE with higher TMAO, by HF phenotype (subgroup)
| Comparison | HR (95% CI) | |
|---|---|---|
| Higher TMAOHFrEF; I2 0% | 1.43 (1.15–1.78) | |
| Higher TMAOHFpEF; I2 31.6% | 1.76 (1.21–2.55) | |
| 0.20.5125Hazard ratio (log scale) |
Meta-regression
- No significant effect modification by baseline age, NT-proBNP, renal function or BMI
Original publication
Gut microbiome-derived metabolites as prognostic biomarkers in heart failure: a systematic review and meta-analysis. Eur J Heart Fail. Published 1 September 2026. doi:10.
Summarised from the published abstract; every number is checked against it