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According to the leaky gut theory, these alterations in gut microbiota may be related to inadequate perfusion to the viscera due to cardiac congestion or impaired ejection capacity in patients with HF, and ischemic edema in the intestine caused by ischemia, which might increase the permeability of the intestinal epithelium (Sandek et al., 2007), thus allowing intestinal macrobiotic and bacterial metabolites to gain access to the circulatory system through the compromised barrier

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however, additional research is required before any conclusions can be drawn