Pancreatic Exocrine Insufficiency in Heart Failure
Heart failure and pancreatic exocrine insufficiency: pathophysiological mechanisms and clinical point of view
Heart failure is a syndrome consisting of different hallmarks and therefore capable to inflict many organs in the body. For example, due to hemodynamic perturbations (such as hypoperfusion and congestion), tissue damage can occur. This is already studied in the kidney’s, liver, brain and so on, but barely in the pancreas. A few animal- and obduction studies have investigated the effects of heart failure on the pancreas. They have shown the pancreas is an organ susceptible to ischemic damage. In humans, the effects of heart failure on the pancreatic tissue is rarely explored.
The pancreas contains two types of tissue, the endocrine and the exocrine part. Prior research has mostly been focused on the endocrine function, demonstrating impaired signaling and enhanced insulin clearance. However, the pancreas tissue consists mostly of exocrine tissue, the acinar cells. These cells are the functioning unit of the exocrine pancreas, producing several digestion enzymes. Therefore, the pancreas plays a significant role in the digestion and absorption of (micro)nutrients. In case of exocrine pancreatic exocrine insufficiency, malabsorption can occur, leading to malnutrition.
In patients who are diagnosed with end-stage heart failure, malnutrition, weight loss and sarcopenia can be seen. This syndrome is called cardiac cachexia. The pathophysiological mechanisms of this phenomenon are unclear. We hypothesize that (a decline in) exocrine pancreatic function can play a key role in this process. Recently, it has become clear that deficiencies of micronutrients can lead to worsening heart failure. What follows is a vicious circle, where different organ dysfunctions deteriorate each other.
Recently, Olivier Dams and Marlene Vijver published a review addressing this novel theory, under supervision of professor Dirk Jan van Veldhuisen. More research is needed to further explore the possible pathophysiological mechanisms. Currently we are conducting an observational study, whereby we aim to investigate the prevalence of exocrine pancreatic insufficiency in patients with heart failure.