Pancreatic involvement in the course of acute heart failure - insights from the AVANTI trial
M A T Vijver, O C Dams, G H D Voordes, R C Verdonk, A A Voors, S R Goldsmith, L Monzo, N Gerard, R Frost, D Burkhoff, F Gustafsson, K Duarte, F Zannad, J E Udelson, D J Van VeldhuisenAbstract
Background
Acute heart failure (AHF) is associated with end-organ injury. Whether AHF also affects the pancreas, is unknown.
Aim
To study the course of serum lipase (marker for pancreatic damage) during and beyond hospitalization for AHF.
Methods
Patients who had been enrolled in an AHF trial (AVANTI (1)) were examined. Serum lipase levels were evaluated at baseline (day 1 of the study), day 7 and 30. Courses of enzymes were analysed using linear mixed models, and outcomes were compared to the simultaneously measured trajectories of hepatic enzymes (alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT).
Results
We studied 480 patients, who were 69 ± 11 years old, and 25% were women. More than half (61%) of them had a reduced left ventricular ejection fraction (<50%). Lipase levels showed a small, but significant increase from day 1 to day 7 (1 [-6, 10]U/L, p=0.011) followed by a minor decrease (-2 [-11, 6]U/L, p=0.002). ALT and AST increased modestly between day 1 and 7 and decreased thereafter, whereas GGT remained stable before declining between day 7 and 30. Patients in the highest N-terminal pro-B-type natriuretic peptide (NT-proBNP) quartile showed higher lipase levels compared to the lowest quartile (35 [25-54]U/L versus 40 [30-55]U/L, p=0.040). Patients within the highest quartile based on lipase level, also exhibited higher AST and GGT (both p<0.001 compared to the lowest quartile).
Conclusion
Serum lipase shows a small but significant transient increase in patients with AHF, paralleling hepatic enzymes, and correlating with NT-proBNP, suggesting mild pancreatic involvement.