The evaluation of malnutrition with blood Ghrelin and fecal elastase levels in acute decompensated heart failure patients

Özcan, Mustafa; Öztürk, Güzin Zeren; Köse, Murat; Emet, Samim; Aydin, Sengul; Arslan, Kadem; Arman, Yücel; Akkaya, Vakur; Tükek, Tufan

doi:10.5543/tkda.2015.06606

Cited by 7 publications

(7 citation statements)

References 6 publications

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“…The increased level of ghrelin among the HFrEF patients correlates with previous literature reports [26,27]. However, there is no data available for the characteristic levels of ghrelin among patients with HFpEF.…”

Section: Discussionsupporting

confidence: 84%

The differences in the relationship between diastolic dysfunction, selected biomarkers and collagen turn-over in heart failure patients with preserved and reduced ejection fraction

et al. 2017

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Background: The aim of the study was to assess the correlation of the selected biomarkers and collagen turn-over indices with advanced echocardiographic parameters among patients with preserved and reduced ejection fraction (EF .6). Clinical evaluation included 6-min walk test, biochemistry, procollagen type I N-terminal propeptide (PINP), procollagen type III N-terminal propetide (PIIINP), matrix metaloproteinase-2 (MMP2), ghrelin, and galectin-3 levels measurements. Echocardiographic examination was performed with analysis of diastolic function and global longitudinal strain (GLS). Results: The GLS in the HFrEF group was significantly lower than in the HFpEF group at the baseline (GLS: 9.56 vs. 16.03, p < 0.01). There was a strong negative correlation of the p = 0.005), but only a moderate negative correlation in p = 0.02). In the HFrEF group, there was a moderate negative correlation between the baseline level of p = 0.03). The correlation of ghrelin and tissue inhibitor of matrix metalloproteinase-1 with EF in the HFrEF group was moderate and statistically significant (r = 0.62, p = 0.02 and r = -0.63, p = 0.02, respectively). Conclusions: Procollagen type III peptide has a strong negative correlation with left ventricular GLS. Galectin-3 relationship with strain may indicate novel pathophysiological pathways and requires further investigation. (Cardiol J 2017; 24, 1: 35-42)

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Section: Discussionsupporting

confidence: 84%

The differences in the relationship between diastolic dysfunction, selected biomarkers and collagen turn-over in heart failure patients with preserved and reduced ejection fraction

et al. 2017

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“…Three studies assessed the incidence of PEI in patients with CHF as a primary outcome[17-19] and five studies assessed incidence of cardiovascular complication (acute or chronic coronary lesion, carotid atheroma, peripheral arterial lesion) in patients with CP[4-6,20,21]. Improvement of appetite loss by supplemented pancreatic enzymes was investigated as a secondary outcome in the study by Xia et al[17].…”

Section: Resultsmentioning

confidence: 99%

Chronic pancreatitis and the heart disease: Still terra incognita?

Nikolic¹,

Dugic²,

Steiner³

et al. 2019

WJG

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BACKGROUNDIt has been suggested that chronic pancreatitis (CP) may be an independent risk factor for development of cardiovascular disease (CVD). At the same time, it seems that congestive heart failure (CHF) and CP share the responsibility for the development of important clinical conditions such as sarcopenia, cachexia and malnutrition due to development of cardiac cachexia and pancreatic exocrine insufficiency (PEI), respectively.AIMTo explore the evidence regarding the association of CP and heart disease, more specifically CVD and CHF.METHODSA systematic search of MEDLINE, Web of Science and Google Scholar was performed by two independent investigators to identify eligible studies where the connection between CP and CVD was investigated. The search was limited to articles in the English language. The last search was run on the 1st of May 2019. The primary outcomes were: (1) Incidence of cardiovascular event [acute coronary syndrome (ACS), chronic coronary disease, peripheral arterial lesions] in patients with established CP; and (2) Incidence of PEI in patients with CHF.RESULTSOut of 1166 studies, only 8 were eligible for this review. Studies regarding PEI and CHF showed an important incidence of PEI as well as associated malabsorption of nutritional markers (vitamin D, selenium, phosphorus, zinc, folic acid, and prealbumin) in patients with CHF. However, after substitution of pancreatic enzymes, it seems that, at least, loss of appetite was attenuated. On the other side, studies investigating cardiovascular events in patients with CP showed that, in CP cohort, there was a 2.5-fold higher incidence of ACS. In another study, patients with alcohol–induced CP with concomitant type 3c diabetes had statistically significant higher incidence of carotid atherosclerotic plaques in comparison to patients with diabetes mellitus of other etiologies. Earlier studies demonstrated a marked correlation between the clinical symptoms in CP and chronic coronary insufficiency. Also, statistically significant higher incidence of arterial lesions was found in patients with CP compared to the control group with the same risk factors for atherosclerosis (hypertension, smoking, dyslipidemia). Moreover, one recent study showed that PEI is significantly associated with the risk of cardiovascular events in patients with CP.CONCLUSIONCurrent evidence implicates a possible association between PEI and malnutrition in patients with CHF. Chronic pancreatic tissue hypoxic injury driven by prolonged splanchnic hypoperfusion is likely to contribute to malnutrition and cachexia in patients with CHF. On the other hand, CP and PEI seem to be an independent risk factor associated with an increased risk of cardiovascular events.

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“…These results were generally consistent with previous studies investigating AHF and CHF. 20 – 23 It has been reported that acute increases in ghrelin do not interfere with cardiac metabolism in normal individuals, whereas they enhance free fatty acid oxidation and reduce glucose oxidation in HF, thus partially correcting metabolic alterations during AHF. 24 Ghrelin also reduces mean arterial blood pressure, increases myocardial contractility, inhibits cardiomyocyte and endothelial cell apoptosis, and decreases sympathetic nerve activity via AMPK, AKT, ERK1/2, and GSK3 α/β pathways, 25 all of which play beneficial roles in early HF stages.…”

Section: Discussionmentioning

confidence: 99%

“…Elevated ghrelin levels directly decreased blood pressure, and inhibited sympathetic drive in AHF patients, which was related to AHF severity, potentially indicating a poor HF prognosis. 20 , 23 , 31 Incremental ghrelin levels are not only associated with cardio-protective effects via GH-dependent or independent pathways, but are also attributed to their correlation with nutritional status. Risk of malnutrition has been implicated in HF development and progression.…”

Section: Discussionmentioning

confidence: 99%

<p>The Additional Prognostic Value of Ghrelin for Mortality and Readmission in Elderly Patients with Acute Heart Failure</p>

Yuan¹,

Huang²,

Deng³

et al. 2020

CIA

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Purpose: To evaluate the prognostic value of ghrelin, a growth hormone-releasing peptide, for mortality and readmission in elderly patients with acute heart failure (AHF). Patients and Methods: We measured plasma ghrelin and pro B-type natriuretic peptide (NT-proBNP) levels upon emergency admission in 241 prospectively recruited elderly AHF patients (61.0% men). The outcomes were all-cause mortality and/or readmission due to heart failure (HF). Multivariate Cox proportional hazards regression analyses were used to evaluate the prognostic value of ghrelin. Discrimination, calibration, and reclassification indices were compared between models, with or without ghrelin. Results: During 1.2 years of follow-up, we observed 90 events (57 deaths and 33 readmissions due to HF). Plasma ghrelin levels were significantly elevated in elderly AHF patients, when compared to healthy control subjects (P < 0.001). Patients with events had significantly higher baseline ghrelin levels, when compared to those without (P < 0.001). Ghrelin levels were positively correlated with NT-proBNP levels and HF severity, whereas they were negatively correlated with nutritional status (all P < 0.05). Log transformed ghrelin levels were independently associated with AHF events (hazard ratio = 2.64, 95% confidence interval = 1.11-6.25, P = 0.028). The incorporation of ghrelin into the reference model, or reference with the NT-proBNP model, both improved C-statistics (from 0.742-0.780 and 0.836-0.857; P = 0.074 and 0.044, respectively), resulting in an improvement in net reclassification index (14.42% and 10.45%, P = 0.020 and 0.025, respectively), and integrated discrimination index (5.64% and 3.60%, both P < 0.001). Patients who displayed the above NT-proBNP and ghrelin median levels had a markedly higher risk of AHF adverse events (P < 0.001). Conclusion: Plasma ghrelin is an independent predictor of adverse events in elderly AHF patients. Ghrelin may provide additional value to clinical parameters or NT-proBNP for prognostic risk stratification in AHF.

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The evaluation of malnutrition with blood Ghrelin and fecal elastase levels in acute decompensated heart failure patients

Abstract: Fecal elastase and ghrelin hormone levels can contribute to the determination of malnutrition in ADHF patients.

Cited by 7 publications

References 6 publications

The differences in the relationship between diastolic dysfunction, selected biomarkers and collagen turn-over in heart failure patients with preserved and reduced ejection fraction

The differences in the relationship between diastolic dysfunction, selected biomarkers and collagen turn-over in heart failure patients with preserved and reduced ejection fraction

Chronic pancreatitis and the heart disease: Still terra incognita?

<p>The Additional Prognostic Value of Ghrelin for Mortality and Readmission in Elderly Patients with Acute Heart Failure</p>

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