Heart failure and the exocrine pancreas
Heart failure and the exocrine pancreas
Heart failure is a systemic disease; however, little is known about its effects on the exocrine pancreas. Impairment of exocrine pancreatic function can lead to exocrine pancreatic insufficiency, a treatable condition. The thesis of Marlene Vijver demonstrates that the exocrine pancreas is likely an underrecognized target organ in heart failure.
The findings support the concept that reduced organ perfusion, venous congestion, and possibly chronic low-grade inflammation contribute to pancreatic injury. In patients hospitalized with acute heart failure, subtle but consistent increases in the pancreatic enzymes amylase and lipase were observed, suggesting mild pancreatic cellular injury. Furthermore, post-mortem pancreatic tissue from patients with heart failure showed signs of inflammation and haemorrhage, indicating structural pancreatic damage. Among patients with chronic heart failure, approximately one in ten had exocrine pancreatic insufficiency. These patients more frequently had a lower body weight, features of malnutrition and cardiac cachexia, lower circulating lipase levels, and evidence of right-sided cardiac dysfunction.
Overall, the findings of this thesis suggest that the pancreas may contribute to the systemic manifestations of heart failure. Based on the current evidence, routine screening for pancreatic injury or exocrine pancreatic dysfunction is not recommended. However, targeted diagnostic evaluation may be valuable in patients with heart failure who present with unexplained weight loss, persistent nutritional deficiencies, or other signs suggestive of malabsorption. Future studies should establish the prevalence and determinants of exocrine pancreatic dysfunction in heart failure and determine whether pancreatic enzyme replacement therapy can improve clinical outcomes in selected patients with heart failure.