Clinical characteristics of gut microbiota translocation after acute myocardial infarction and its impact on prognosis

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Objective To systematically analyze the clinical characteristics of gut microbiota translocation in patients after acute myocardial infarction (AMI), explore the relationships among intestinal barrier dysfunction, gut microbiota changes, inflammatory response, and cardiac function impairment, and further evaluate its association with short-term prognosis, so as to provide new clinical evidence for risk stratification and comprehensive intervention in AMI patients. Methods This study adopted a single-center retrospective cohort design. A total of 148 patients with AMI who were hospitalized in the Department of Cardiology of our hospital and received standardized treatment from April 2023 to June 2025 were selected as the study subjects (AMI group), and 110 healthy volunteers who underwent physical examination during the same period were included as the control group. Venous blood and fecal samples had been collected within 24 h after admission or on the day of physical examination as part of the routine clinical laboratory or health examination workflow, and the corresponding laboratory results were retrospectively extracted for this study. Serum D-lactic acid (D-LA), diamine oxidase (DAO), and lipopolysaccharide (LPS) levels were detected by enzyme-linked immunosorbent assay to evaluate intestinal barrier function and microbiota translocation; the quantities of five representative gut microbiota, including Bifidobacterium, Lactobacillus, Bacteroides, Enterobacter, and Enterococcus, were detected by gut microbiota culture. According to serum LPS levels and intestinal barrier indicators, the presence of gut microbiota translocation was comprehensively determined, and patients were divided into a translocation group ( n = 52) and a non-translocation group ( n = 96). General clinical data and relevant laboratory indicators were collected, including C-reactive protein (CRP), white blood cell count (WBC), N-terminal pro-brain natriuretic peptide (NT-proBNP), and left ventricular ejection fraction (LVEF). All patients were followed for 90 days after discharge, and newly occurring major adverse cardiovascular events (MACE) during the follow-up period, including heart failure, malignant arrhythmia, recurrent myocardial infarction, and cardiac death, were recorded. Pearson correlation analysis was used to explore the relationships between gut-related indicators and inflammatory indicators as well as cardiac function indicators, and multivariable logistic regression analysis was used to explore factors associated with short-term poor prognosis in patients with AMI. Results Compared with the control group, serum D-LA, DAO, and LPS levels were significantly increased in the AMI group ( P < 0.05). Meanwhile, the gut microbiota structure of AMI patients was markedly disturbed, manifested by a significant decrease in putatively beneficial or commensal bacteria, including Bifidobacterium, Lactobacillus, and Bacteroides, and a significant increase in opportunistic/pathobiont bacteria such as Enterobacter and Enterococcus (P<0.05). Further subgroup analysis showed that, compared with the non-translocation group, the translocation group had more obvious gut microbiota disturbance, characterized by decreased levels of Bifidobacterium, Lactobacillus, and Bacteroides and increased levels of Enterobacter and Enterococcus ( P < 0.05). Because D-LA, DAO, and LPS were used to define translocation status, their subgroup differences were not interpreted as independent findings. In addition, CRP, WBC, and NT-proBNP levels were significantly higher in the translocation group than in the non-translocation group, whereas LVEF was significantly lower in the translocation group ( P < 0.05). Follow-up results showed that the incidence of MACE within 90 d was significantly higher in the translocation group than in the non-translocation group, with the most significant increases observed in acute heart failure and malignant arrhythmia ( P < 0.05). Correlation analysis showed that D-LA, DAO, LPS, Enterobacter, and Enterococcus were significantly positively correlated with CRP, WBC, and NT-proBNP levels and significantly negatively correlated with LVEF ( P < 0.05); Bifidobacterium, Lactobacillus, and Bacteroides were negatively correlated with CRP, WBC, and NT-proBNP and positively correlated with LVEF (P < 0.05). These correlation results remained statistically significant after Benjamini-Hochberg FDR correction. Exploratory multivariable logistic regression analysis suggested that elevated levels of LPS, DAO, and NT-proBNP, decreased LVEF, and increased abundances of Enterobacter and Enterococcus were associated with poor short-term prognosis in patients with AMI ( P < 0.05). However, because only 32 patients experienced at least one MACE, these regression results should be interpreted cautiously because of the limited events-per-variable ratio. Conclusion AMI patients exhibit marked intestinal barrier dysfunction and gut microbiota translocation during the acute phase, characterized by elevated levels of D-LA, DAO, and LPS, with concomitant decreases in putatively beneficial or commensal bacteria, including Bifidobacterium, Lactobacillus, and Bacteroides, and increases in opportunistic/pathobiont bacteria such as Enterobacter and Enterococcus. The degree of gut microbiota translocation is closely associated with enhanced inflammatory response, worsening cardiac function, and the occurrence of short-term adverse cardiovascular events, suggesting that the “ gut-heart axis “ may play an important role in disease progression and prognostic evolution after AMI. Intestinal barrier function and microbiota translocation-related indicators may serve as potential auxiliary biomarkers for prognostic risk assessment in AMI patients and provide new research directions for future gut microbiota intervention strategies.

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