Heart Failure and Pancreas Exocrine Insufficiency: Pathophysiological Mechanisms and Clinical Point of View

Abstract

Heart failure is associated with decreased tissue perfusion and increased venous congestion that may result in organ dysfunction. This dysfunction has been investigated extensively for many organs, but data regarding pancreatic (exocrine) dysfunction are scarce. In the present review we will discuss the available data on the mechanisms of pancreatic damage, how heart failure can lead to exocrine dysfunction, and its clinical consequences. We will show that heart failure causes significant impairment of pancreatic exocrine function, particularly in the elderly, which may exacerbate the clinical syndrome of heart failure. In addition, pancreatic exocrine insufficiency may lead to further deterioration of cardiovascular disease and heart failure, thus constituting a true vicious circle. We aim to provide insight into the pathophysiological mechanisms that constitute this reciprocal relation. Finally, novel treatment options for pancreatic dysfunction in heart failure are discussed.

Fat malabsorption in critical illness

“…31 Interestingly, the changes in splanchnic circulation necessary to induce pancreatic insult may occur before changes in other, more easily identified end-organ perfusion markers, such as renal perfusion. 32 Regardless of the underlying mechanism, there is evidence that EPI is a clinically significant entity among those who are critically ill. In a sample of >500 patients who were critically ill, stool fecal elastase, serum lipase, and amylase levels were measured 3-5 days after the initiation of enteral nutrition via nasojejunal tube.…”

“…The precise mechanisms leading to pancreatic insult and the resulting EPI are not completely understood; however, relative pancreatic ischemia is thought to be the primary underlying insult among patients with septic shock 31 . Interestingly, the changes in splanchnic circulation necessary to induce pancreatic insult may occur before changes in other, more easily identified end‐organ perfusion markers, such as renal perfusion 32 . Regardless of the underlying mechanism, there is evidence that EPI is a clinically significant entity among those who are critically ill.…”

Association of Cardiovascular Disease and Pancreatitis: What Came First, the Chicken or the Egg?

“…Ozcan et al found a significant difference in fecal elastase levels between patients with severe acute decompensated heart failure (HF) (50% with severe PEI and 20% with moderate PEI) vs. the control and mild acute decompensated HF group (around two-thirds had normal pancreatic function) [49]. Dam et al proposed that the acceleration of the development of PEI was related to deranged hemodynamics (e.g., congestion and hypoperfusion), chronic inflammation, and autonomic dysfunction of the pancreas [52]. On the contrary, PEI can aggravate the wasting of advanced HF and may result in micronutrient deficiencies, further deteriorating heart failure [52].…”

“…Dam et al proposed that the acceleration of the development of PEI was related to deranged hemodynamics (e.g., congestion and hypoperfusion), chronic inflammation, and autonomic dysfunction of the pancreas [52]. On the contrary, PEI can aggravate the wasting of advanced HF and may result in micronutrient deficiencies, further deteriorating heart failure [52].…”

Insuficiencia Cardiaca Aguda Asociada a Pancreatitis Aguda: Reporte de Caso

“…La insuficiencia cardíaca es un síndrome clínico causado por trastornos estructurales o funcionales, los cuales provocan un deterioro del llenado ventricular o la fracción de eyección asociado a una disminución del gasto (insuficiencia anterógrada) y un aumento de la congestión (insuficiencia retrógrada) que conduce a una disfunción orgánica diseminada (1).…”