50 | Gut dysbiosis, microbiome and heart failure. the gut-heart axis and eating habits in frail elderly with polipathology. a clinical case report.

Introduction. Gut and heart connection involves gut microbiota, immune system, and autonomic nervous system. Alterated gut microbiota (dysbiosis) and an inappropiate diet can promote cardiac diseases as heart failure. Normally shortchain fatty acids (SCFAs) have antinflammatory effects. During dysbiosis TMAO (trimethylamine N-oxide)increases endothelium permeability so bacteria and toxins pass into the blood. This relationship is more evident in frail patients usually elderly with multiple diseases, polypharmacy, reduction in functional reserve. Frailty is frequent in heart failure. Objectives. Show how a good dietary approach, modifying microbiota composition, in a frail elderly subject with heart disease and frequent episodes of intestinal dysbiosis, can improve cardiac function, frailty and prognosis. Materials and Methods. Woman 88 years old, affected by atrial fibrillation, hypertension, heart failure (NYHA II), mitral valve stenosis, episodes of intestinal dysbiosis associated with worsening cardiac function. We revealed a poor dietary intake of food with fiber. She was followed for two years making changes in the diet components introducing or increasing fibers and fermented foods. We performed the Multidimensional Prognostic Index (MPI) and the Rockwood Frailty Clinical Index. Results. Without dysbiosis NYHA class was II; Rockwood Frailty Index score of 4 (vulnerable), one-year mortality risk: 0.22(low). During dysbiosis NYHA class was III-IV; Rockwood Frailty Index was from 6 to 8 (moderately to very severely frail), one-year mortality risk moderate (0.66) or severe (0.80). Changing diet led to a reduction of dysbiosis and improvement of prognostic and frailty indices. At the end prognostic and frailty indices were similar to the data recorded without episodes of dysbiosis. Conclusions. A fiber-rich diet has a positive impact on gut microbiota, reduces inflammation, prevents cardiovascular disease and in the elderly improves prognostic and frailty indicators.