8. Periodontitis As A Possible Cause Of Chronic Heart Failure
DOI:
https://doi.org/10.35805/BSK2025III008Downloads
Abstract
Background. The objective of this study was to investigate the prevalence of periodontitis in patients with chronic heart failure, as well as to characterize the microbiological profile of periodontitis across different chronic heart failure phenotypes. The objective is to analyze the link between oral health and heart disease.
Materials and Methods. A cohort of 98 chronic heart failure patients (mean age 62.22 ± 8.62 years, 69 men) was assessed through comprehensive cardiological and periodontal examinations. Patients were categorized into heart failure with reduced ejection fraction, mildly reduced ejection fraction, and preserved ejection fraction. Periodontal parameters, including probing pocket depth, clinical attachment loss, and bleeding on probing were evaluated. Microbiological and statistical analyses were conducted.
Results. Severe periodontitis (Stage C) was identified in 30% of patients, while 48% had moderate periodontitis (Stage B). Patients with chronic heart failure with reduced ejection fraction exhibited the highest prevalence of severe periodontitis, with a significant correlation between increased probing pocket depth and reduced ejection fraction. Candida species abundance was associated with lower ejection fraction (p≤0.0Y) and advanced periodontitis (p≤0.0X). Elevated NT-proBNP levels (1121.00–7611.00 pg/mL) correlated with Streptococcus mitis prevalence, while C-reactive protein levels (up to 2.35 mg/dL) were highest in patients with Klebsiella pneumoniae.
Conclusion. The study highlights a strong association between periodontal disease, microbial dysbiosis, and CHF. Findings suggest that oral microbial imbalances, particularly involving Candida, Streptococcus mitis, and Klebsiella pneumoniae, contribute to systemic inflammation and cardiovascular complications.
Keywords
dental health surveys, gingiva pathology, heart failure, inflammation, periodontal index
References
- Schulze A, Kwast S, Pokel C, Busse M. Assessment of the Relationship between Periodontitis and Cardiac Parameters in Patients with Early Chronic Heart Failure: A Cross-Sectional Study. J Funct Morphol Kinesiol. Mar 18 2024;9(1). doi:10.3390/jfmk9010052
- Huh Y, Yoo JE, Park SH, et al. Association of Dental Diseases and Oral Hygiene Care With the Risk of Heart Failure in Patients With Type 2 Diabetes: A Nationwide Cohort Study. J Am Heart Assoc. Aug 15 2023;12(16):e029207. doi:10.1161/JAHA.122.029207
- Molinsky RL, Yuzefpolskaya M, Norby FL, et al. Periodontal Status, C-Reactive Protein, NT-proBNP, and Incident Heart Failure: The ARIC Study. JACC Heart Fail. Oct 2022;10(10):731-741. doi:10.1016/j.jchf.2022.05.008
- Zusli S, Bierreth F, Boesing M, et al. Point of care with serial NT-proBNP measurement in patients with acute decompensated heart failure as a therapy-monitoring during hospitalization (POC-HF): Study protocol of a prospective, unblinded, randomized, controlled pilot trial. Contemp Clin Trials Commun. Sep 2021;23:100825. doi:10.1016/j.conctc.2021.100825
- Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. May 3 2022;145(18):e876-e894. doi:10.1161/CIR.0000000000001062
- Mohamed A, Hall C, Hatch M, Ayan M, Winn R. Infective endocarditis caused by Klebsiella oxytoca in an intravenous drug user with cancer. Proc Bayl Univ Med Cent. Apr 2016;29(2):181-2. doi:10.1080/08998280.2016.11929408
- Hassan SA, Akhtar A, Falah NU, Khan M. An Unusual Case of Klebsiella pneumoniae Endocarditis. Cureus. Feb 14 2020;12(2):e6999. doi:10.7759/cureus.6999
- Erratum: ATS Statement: Guidelines for the Six-Minute Walk Test. Am J Respir Crit Care Med. May 15 2016;193(10):1185. doi:10.1164/rccm.19310erratum
- Ioannou P, Miliara E, Baliou S, Kofteridis DP. Infective endocarditis by Klebsiella species: a systematic review. J Chemother. Oct 2021;33(6):365-374. doi:10.1080/1120009X.2021.1888025
- Schulze-Spate U, Mizani I, Salaverry KR, et al. Periodontitis and bone metabolism in patients with advanced heart failure and after heart transplantation. ESC Heart Fail. May 2017;4(2):169-177. doi:10.1002/ehf2.12126
- Liccardo D, Cannavo A, Spagnuolo G, et al. Periodontal Disease: A Risk Factor for Diabetes and Cardiovascular Disease. Int J Mol Sci. Mar 20 2019;20(6). doi:10.3390/ijms20061414
- Luthra S, Orlandi M, Hussain SB, et al. Treatment of periodontitis and C-reactive protein: A systematic review and meta-analysis of randomized clinical trials. J Clin Periodontol. Jan 2023;50(1):45-60. doi:10.1111/jcpe.13709
- Gomes-Filho IS, Freitas TOB, Cruz SSD, et al. Periodontitis in individuals with few remaining teeth and a high gingival bleeding index increases the probability of dyslipidemia. J Periodontol. Oct 2023;94(10):1243-1253. doi:10.1002/JPER.23-0091
- Kosho MXF, Verhelst ARE, Teeuw WJ, Gerdes VEA, Loos BG. Cardiovascular risk assessment in periodontitis patients and controls using the European Systematic COronary Risk Evaluation (SCORE) model. A pilot study. Front Physiol. 2022;13:1072215. doi:10.3389/fphys.2022.1072215
- Gugnani N, Gugnani S. Can treatment of severe periodontitis in patients with ST-segment elevation myocardial infarction improve endothelial function? Evid Based Dent. Jan 2021;22(1):5-7. doi:10.1038/s41432-021-0157-3