Pancreatic exocrine insufficiency in heart failure

Heart failure (HF) is a complex clinical syndrome resulting from any functional
or structural heart disorder, impairing ventricular filling or ejection of
blood to the systemic circulation to meet the systemic needs [1,2].
Hemodynamically this results in congestion and/or hypoperfusion, and a
widespread neurohormonal and inflammatory response. Ultimately this leads to
impairment and/or failure of target organs, of which the kidney [3,4], liver
[5,6], brain [7,8] and intestines [6,9,10] have been widely studied. The
influence of these hemodynamic perturbations on the pancreas, however, has not
been well documented. This is striking, given the high degree of congestion in
the abdominal compartment [11], the susceptibility of the pancreas to ischemia
[12-15] and increased venous pressures [12] and the prevalence of malnutrition
and appetite loss among the (advanced) HF population.

The pancreas is principally an exocrine gland, responsible for discharging
digestive enzymes and bicarbonate into a system of intercalated ducts emptying
into the proximal duodenum. There seems to be an age-dependent decline in
exocrine pancreatic parenchyma, which is likely related to decreased perfusion
[16]. Although studies are scarce, HF also seems to lead to exocrine pancreatic
insufficiency (EPI) [13,17]. EPI results in maldigestion and malnutrition,
which in patients with (advanced) HF, could aggravate the development and
consequences of cardiac cachexia, a hallmark and strong independent prognostic
factor [18-20]. Unfortunately, no studies on the prevalence and consequences of
EPI in the advanced HF population, who are most susceptible to pancreatic
injury and cardiac cachexia, exist.

It is hypothesized HF is associated with pancreatic congestion leading to
exocrine pancreatic insufficiency (EPI) and this in turn contributes to loss of
appetite and the syndrome of cardiac cachexia [21]. The aim of this study is to
investigate EPI in the HF population and to determine its association with
markers of congestion and appetite loss. The results would increase our
understanding of HF-related target organ impairment and contribute to therapies
such as dietary intervention or pancreatic enzyme supplementation in the HF
population.

Primary Objective:
The primary objective of this study is to investigate the prevalence EPI in the
advanced HF population

Secondary Objectives:
• To determine the association between exocrine pancreatic function and markers
of HF
• To determine the association between exocrine pancreatic function and
patient-reported outcome related to HF
• To determine the association between exocrine pancreatic function and vitamin
status
• To determine the association between exocrine pancreatic function and loss of
appetite
• To determine the association between exocrine pancreatic function and the
prevalence of weight-loss

The current study is a single center, cross-sectional, case-control
observational study. A total of 30 patients diagnosed with chronic advanced HF
at the University Medical Center Groningen (UMCG) cardiology department will be
recruited. These patients are matched for sex and age with 30 controls with
mild HF. This study will be performed at the outpatient clinic and the wards of
the UMCG department of cardiology.

Participants are burdened with additional blood sampling through vena puncture.
Additionally, participants are burdened with non-invasive fecal sampling and
testing and administration of patient-reported outcome measures.
There are no significant risks associated with this study.