Figure 1. “Gut hypothesis” of heart failure and its comorbidities.

Figure 1 shows that hemodynamic features of heart failure (HF), decreased cardiac output and elevated intracardiac filling pressure, cause gut epithelial hypoperfusion and dysfunction, which causes increased intestinal permeability, intestinal malabsorption, altered gut microbiota, and increased sodium and fluid reabsorption, thereby resulting in increased inflammation, cardiac cachexia, insulin resistance, and HF decompensation, respectively.