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Muraoka Y, Miura T, Miyagi M, Okazaki T, Katsumata T, Obata K, Ebihara S. Geriatric Nutritional Risk Index Predicts High Activities of Daily Living at Discharge in Older Patients with Heart Failure after Cardiac Rehabilitation. J Clin Med 2023; 12:7662. [PMID: 38137731 PMCID: PMC10743407 DOI: 10.3390/jcm12247662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Hospitalization often leads to a decline in activities of daily living (ADL) in older patients with heart failure. Although cardiac rehabilitation (CR) improves ADL, it can be difficult to perform CR due to the deconditioning of these patients. This study aimed to examine the factors associated with ADL at discharge in older patients with heart failure who underwent CR. METHODS A total of 86 of 110 older heart failure patients aged ≥ 75 years (average age, 86.9 ± 5.7 years) transferred to our institution for CR were enrolled and classified into high ADL at discharge (n = 54) and low ADL at discharge (n = 32) groups. Physical characteristics, comorbidities, medications, blood test data, echocardiographic data, and nutritional status (Geriatric Nutritional Risk Index [GNRI]) were retrospectively examined from medical records. ADL were assessed using the Barthel Index (BI) at admission and discharge. Considering multicollinearity, the relationship between high ADL (BI ≥ 60) at discharge and these assessments at admission was analyzed using multiple logistic regression analysis. The receiver operating characteristic curve was analyzed to calculate the cutoff values for the parameters identified by the multiple logistic regression analysis. RESULTS The GNRI was the only independent factor predicting high ADL at discharge (p = 0.041; odds ratio [OR], 1.125; 95% confidence interval [CI], 1.005-1.260). The area under the receiver operating characteristic curve for the GNRI was 0.770 (95% CI, 0.664-0.876). The cutoff value for the GNRI was 83.4 (sensitivity, 85.2%; specificity, 62.5%). CONCLUSION These findings suggest that the GNRI score at admission predicts high ADL at discharge in older patients with heart failure who underwent CR.
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Affiliation(s)
| | | | | | | | | | | | - Satoru Ebihara
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine, Sendai 980-8574, Japan; (Y.M.); (T.M.); (M.M.); (T.O.); (T.K.); (K.O.)
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2
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Kitzerow O, Suder P, Shukry M, Lisco SJ, Zucker IH, Wang HJ. Systemic mapping of organ plasma extravasation at multiple stages of chronic heart failure. Front Physiol 2023; 14:1288907. [PMID: 38033338 PMCID: PMC10687360 DOI: 10.3389/fphys.2023.1288907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction: Chronic Heart failure (CHF) is a highly prevalent disease that leads to significant morbidity and mortality. Diffuse vasculopathy is a commonmorbidity associated with CHF. Increased vascular permeability leading to plasma extravasation (PEx) occurs in surrounding tissues following endothelial dysfunction. Such micro- and macrovascular complications develop over time and lead to edema, inflammation, and multi-organ dysfunction in CHF. However, a systemic examination of PEx in vital organs among different time windows of CHF has never been performed. In the present study, we investigated time-dependent PEx in several major visceral organs including heart, lung, liver, spleen, kidney, duodenum, ileum, cecum, and pancreas between sham-operated and CHF rats induced by myocardial infarction (MI). Methods: Plasma extravasation was determined by colorimetric evaluation of Evans Blue (EB) concentrations at 3 days, ∼10 weeks and 4 months following MI. Results: Data show that cardiac PEx was initially high at day 3 post MI and then gradually decreased but remained at a moderately high level at ∼10 weeks and 4 months post MI. Lung PEx began at day 3 and remained significantly elevated at both ∼10 weeks and 4 months post MI. Spleen PExwas significantly increased at ∼10 weeks and 4 months but not on day 3 post MI. Liver PEx occurred early at day 3 and remain significantly increased at ∼10 weeks and 4 months post MI. For the gastrointestinal (GI) organs including duodenum, ileum and cecum, there was a general trend that PEx level gradually increased following MI and reached statistical significance at either 10 weeks or 4 months post MI. Similar to GI PEx, renal PEx was significantly elevated at 4 months post MI. Discussion: In summary, we found that MI generally incites a timedependent PEx of multiple visceral organs. However, the PEx time window for individual organs in response to the MI challenge was different, suggesting that different mechanisms are involved in the pathogenesis of PEx in these vital organs during the development of CHF.
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Affiliation(s)
- Oliver Kitzerow
- Department of Genetics Cell Biology and Anatomy, University of Nebraska Medical Center, Omaha, NE, United States
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Paul Suder
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Mohanad Shukry
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Steven J. Lisco
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Irving H. Zucker
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE, United States
| | - Han-Jun Wang
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE, United States
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3
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Chen B, Moin A, Virk HUH, Jneid H, Virani SS, Krittanawong C. Association of Cardiovascular Disease and Pancreatitis: What Came First, the Chicken or the Egg? J Clin Med 2023; 12:7101. [PMID: 38002718 PMCID: PMC10672425 DOI: 10.3390/jcm12227101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: Recent studies suggest an association between pancreatitis and cardiovascular disease. This article aims to review the available evidence linking cardiovascular disease with acute and chronic pancreatitis. (2) Methods: A comprehensive search was conducted on the PubMed/MEDLINE database from inception to April 2022 using Medical Subject Heading and keywords related to pancreatitis and cardiovascular disease. The search was limited to English-language literature involving human subjects, and various study types, including observational studies, case-control studies, cohort studies, and clinical trials, were screened for eligibility. Following data extraction, the authors conducted a narrative synthesis of the studies. (3) Results: Longitudinal studies indicate that a history of acute pancreatitis is associated with an increased risk of acute atherosclerotic cardiovascular disease and acute coronary syndrome. Elevated triglyceride levels (>2000 mg/dL) have a temporal relationship with acute pancreatitis. Cross-sectional studies have shown that acute pancreatitis is associated with cardiac injury during the acute phase. Based on longitudinal studies, chronic pancreatitis is associated with an increased risk of cerebrovascular diseases. However, data regarding the relationship between chronic pancreatitis and myocardial infarction are conflicting. (4) Conclusions: Based on the available evidence, having a history of acute pancreatitis appears to increase the risk of acute atherosclerotic cardiovascular disease. However, there is insufficient evidence to conclude whether chronic pancreatitis is associated with cardiovascular disease, and no definitive studies have yielded conflicting results.
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Affiliation(s)
- Bing Chen
- Department of Gastroenterology and Hepatology, Geisinger Medical Center, Danville, PA 17822, USA
| | - Aleena Moin
- Department of Internal Medicine-Pediatrics, Geisinger Medical Center, Danville, PA 17822, USA
| | - Hafeez Ul Hassan Virk
- Harrington Heart & Vascular Institute, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH 44106, USA
| | - Hani Jneid
- John Sealy Distinguished Centennial Chair in Cardiology, Division of Cardiology, University of Texas Medical Branch, Houston, TX 77058, USA
| | - Salim S. Virani
- Section of Cardiology and Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, TX 77030, USA
- Office of the Vice Provost (Research), The Aga Khan University, Karachi 74800, Pakistan
| | - Chayakrit Krittanawong
- Cardiology Division, NYU Langone Health and NYU School of Medicine, New York, NY 10016, USA
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4
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Del Rio-Pertuz G, Morataya C, Parmar K, Elharabi Z, Davis D, Abohelwa M, Ochoa O, Tran A, Nugent K, Paniagua D, Argueta-Sosa E. Association between right heart catheterization hemodynamics and glycosylated hemoglobin levels in adults with heart failure with reduced ejection fraction. Cardiovasc Endocrinol Metab 2023; 12:e0285. [PMID: 37361478 PMCID: PMC10287124 DOI: 10.1097/xce.0000000000000285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/20/2023] [Indexed: 06/28/2023]
Abstract
This study hypothesized that elevated glycosylated hemoglobin (HbA1c) levels are associated with abnormal right heart catheterization (RHC) hemodynamic parameters in patients with heart failure with reduced ejection fraction (HFrEF) and no prior diagnosis of diabetes. Methods Retrospective cohort study of adult patients with HFrEF and no prior diagnosis of diabetes who underwent RHC and had HbA1c levels measured 30 days before or after the RHC. This study excluded patients who had received blood transfusions within 90 days prior to HbA1c measurement and patients with known diabetes. Univariate and multivariate regression analyses adjusted for age, sex, and BMI were used to test for an association between RHC hemodynamic parameters and HbA1c levels. Results A total of 136 patients were included with a mean age of 55 ± 15 years and mean HbA1c was 5.99 ± 0.64%. Unadjusted univariate models showed that HbA1c is significantly associated with cardiac index (CI) by the Fick method and thermodilution, right atrial pressure (RAP), and mean pulmonary arterial pressure (MPAP). After multivariate analysis, for every one unit increase in HbA1c, there was a 0.19 and 0.26 L/min/m2 decrease in expected CI by thermodilution and by the Fick method (P = 0.03 and P < 0.01), respectively. For every one unit increase in HbA1c, there was a 2.39 mmHg increase in expected RAP (P = 0.01). Conclusion Elevated HbA1c levels measured within 30 days before or after the index RHC in patients with a left ventricular ejection fraction <40% were associated with congestive hemodynamic parameters.
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Affiliation(s)
| | - Cristina Morataya
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Kanak Parmar
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Zeyad Elharabi
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Daniel Davis
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Mostafa Abohelwa
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Ozman Ochoa
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Alison Tran
- Department of Internal Medicine, Texas Tech University Health Sciences Center
| | - Kenneth Nugent
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Texas Tech University Health Sciences Center Lubbock
| | - David Paniagua
- Department of Internal Medicine, Baylor College of Medicine, Houston
| | - Erwin Argueta-Sosa
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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5
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Makita S, Yasu T, Akashi YJ, Adachi H, Izawa H, Ishihara S, Iso Y, Ohuchi H, Omiya K, Ohya Y, Okita K, Kimura Y, Koike A, Kohzuki M, Koba S, Sata M, Shimada K, Shimokawa T, Shiraishi H, Sumitomo N, Takahashi T, Takura T, Tsutsui H, Nagayama M, Hasegawa E, Fukumoto Y, Furukawa Y, Miura SI, Yasuda S, Yamada S, Yamada Y, Yumino D, Yoshida T, Adachi T, Ikegame T, Izawa KP, Ishida T, Ozasa N, Osada N, Obata H, Kakutani N, Kasahara Y, Kato M, Kamiya K, Kinugawa S, Kono Y, Kobayashi Y, Koyama T, Sase K, Sato S, Shibata T, Suzuki N, Tamaki D, Yamaoka-Tojo M, Nakanishi M, Nakane E, Nishizaki M, Higo T, Fujimi K, Honda T, Matsumoto Y, Matsumoto N, Miyawaki I, Murata M, Yagi S, Yanase M, Yamada M, Yokoyama M, Watanabe N, Ito H, Kimura T, Kyo S, Goto Y, Nohara R, Hirata KI. JCS/JACR 2021 Guideline on Rehabilitation in Patients With Cardiovascular Disease. Circ J 2022; 87:155-235. [PMID: 36503954 DOI: 10.1253/circj.cj-22-0234] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Shigeru Makita
- Department of Cardiac Rehabilitation, Saitama Medical University International Medical Center
| | - Takanori Yasu
- Department of Cardiovascular Medicine and Nephrology, Dokkyo Medical University Nikko Medical Center
| | - Yoshihiro J Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Hitoshi Adachi
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University of Medicine
| | - Shunichi Ishihara
- Department of Psychology, Bunkyo University Faculty of Human Sciences
| | - Yoshitaka Iso
- Division of Cardiology, Showa University Fujigaoka Hospital
| | - Hideo Ohuchi
- Department of Pediatrics, National Cerebral and Cardiovascular Center
| | | | - Yusuke Ohya
- Department of Cardiovascular Medicine, Nephrology and Neurology, Graduate School of Medicine, University of the Ryukyus
| | - Koichi Okita
- Graduate School of Lifelong Sport, Hokusho University
| | - Yutaka Kimura
- Department of Health Sciences, Kansai Medical University Hospital
| | - Akira Koike
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Masahiro Kohzuki
- Department of Internal Medicine and Rehabilitation Science, Tohoku University Graduate School of Medicine
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Masataka Sata
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Kazunori Shimada
- Department of Cardiology, Juntendo University School of Medicine
| | | | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Tetsuya Takahashi
- Department of Physical Therapy, Faculty of Health Science, Juntendo University
| | - Tomoyuki Takura
- Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | | | - Emiko Hasegawa
- Faculty of Psychology and Social Welfare, Seigakuin University
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Yutaka Furukawa
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital
| | | | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Sumio Yamada
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine
| | - Yuichiro Yamada
- Center for Diabetes, Endocrinology and Metabolism, Kansai Electric Power Hospital
| | | | | | - Takuji Adachi
- Department of Physical Therapy, Nagoya University Graduate School of Medicine
| | | | | | | | - Neiko Ozasa
- Cardiovascular Medicine, Kyoto University Hospital
| | - Naohiko Osada
- Department of Physical Checking, St. Marianna University Toyoko Hospital
| | - Hiroaki Obata
- Division of Internal Medicine, Niigata Minami Hospital.,Division of Rehabilitation, Niigata Minami Hospital
| | | | - Yusuke Kasahara
- Department of Rehabilitation, St. Marianna University Yokohama Seibu Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University
| | - Shintaro Kinugawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Yuji Kono
- Department of Rehabilitation, Fujita Health University Hospital
| | - Yasuyuki Kobayashi
- Department of Medical Technology, Gunma Prefectural Cardiovascular Center
| | | | - Kazuhiro Sase
- Clinical Pharmacology and Regulatory Science, Graduate School of Medicine, Juntendo University
| | - Shinji Sato
- Department of Physical Therapy, Teikyo Heisei University
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Norio Suzuki
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Daisuke Tamaki
- Department of Nutrition, Showa University Fujigaoka Hospital
| | - Minako Yamaoka-Tojo
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University
| | - Michio Nakanishi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Mari Nishizaki
- Department of Rehabilitation, National Hospital Organization Okayama Medical Center
| | - Taiki Higo
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kyushu University
| | - Kanta Fujimi
- Department of Rehabilitation, Fukuoka University Hospital
| | - Tasuku Honda
- Department of Cardiovascular Surgery, Hyogo Brain and Heart Center
| | - Yasuharu Matsumoto
- Department of Cardiovascular Medicine, Shioya Hospital, International University of Health and Welfare
| | | | - Ikuko Miyawaki
- Department of Nursing, Kobe University Graduate School of Health Sciences
| | - Makoto Murata
- Department of Cardiology, Gunma Prefectural Cardiovascular Center
| | - Shusuke Yagi
- Department of Cardiovascular Medicine, Tokushima University Graduate School of Biomedical Sciences
| | - Masanobu Yanase
- Department of Transplantation, National Cerebral and Cardiovascular Center
| | | | - Miho Yokoyama
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | | | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Syunei Kyo
- Tokyo Metropolitan Geriatric Medical Center
| | | | | | - Ken-Ichi Hirata
- Department of Internal Medicine, Kobe University Graduate School of Medicine
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6
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Dams OC, Vijver MAT, van Veldhuisen CL, Verdonk RC, Besselink MG, van Veldhuisen DJ. Heart Failure and Pancreas Exocrine Insufficiency: Pathophysiological Mechanisms and Clinical Point of View. J Clin Med 2022; 11:jcm11144128. [PMID: 35887892 PMCID: PMC9324511 DOI: 10.3390/jcm11144128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/28/2022] [Accepted: 07/14/2022] [Indexed: 01/27/2023] Open
Abstract
Heart failure is associated with decreased tissue perfusion and increased venous congestion that may result in organ dysfunction. This dysfunction has been investigated extensively for many organs, but data regarding pancreatic (exocrine) dysfunction are scarce. In the present review we will discuss the available data on the mechanisms of pancreatic damage, how heart failure can lead to exocrine dysfunction, and its clinical consequences. We will show that heart failure causes significant impairment of pancreatic exocrine function, particularly in the elderly, which may exacerbate the clinical syndrome of heart failure. In addition, pancreatic exocrine insufficiency may lead to further deterioration of cardiovascular disease and heart failure, thus constituting a true vicious circle. We aim to provide insight into the pathophysiological mechanisms that constitute this reciprocal relation. Finally, novel treatment options for pancreatic dysfunction in heart failure are discussed.
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Affiliation(s)
- Olivier C. Dams
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.A.T.V.); (D.J.v.V.)
- Correspondence:
| | - Marlene A. T. Vijver
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.A.T.V.); (D.J.v.V.)
| | - Charlotte L. van Veldhuisen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, 1100 DD Amsterdam, The Netherlands; (C.L.v.V.); (M.G.B.)
- Amsterdam Gastroenterology Endocrinology Metabolism, 1100 DD Amsterdam, The Netherlands
| | - Robert C. Verdonk
- Department of Gastroenterology and Hepatology, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands;
| | - Marc G. Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, 1100 DD Amsterdam, The Netherlands; (C.L.v.V.); (M.G.B.)
- Amsterdam Gastroenterology Endocrinology Metabolism, 1100 DD Amsterdam, The Netherlands
| | - Dirk J. van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands; (M.A.T.V.); (D.J.v.V.)
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7
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Shandro BM, Chen J, Ritehnia J, Poullis A. Associations with pancreatic exocrine insufficiency: An United Kingdom single-centre study. World J Clin Cases 2021; 9:9469-9480. [PMID: 34877281 PMCID: PMC8610880 DOI: 10.12998/wjcc.v9.i31.9469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/03/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pancreatic exocrine insufficiency (PEI) is said to be associated with numerous conditions both within and outside the gastrointestinal (GI) system. The majority of research has been concerned with conditions that reduce the volume of functioning pancreatic tissue or prevent adequate drainage to the small bowel, such as chronic pancreatitis, cystic fibrosis, pancreatic cancer and pancreatic resection. However, the evidence base supporting an association with extra-pancreatic conditions, such as coeliac disease, diabetes mellitus and congestive cardiac failure, is heterogeneous.
AIM To strengthen the evidence base by studying all previously reported associations with PEI in a large cohort of outpatients.
METHODS A single-centre retrospective study was performed. General gastroenterology outpatients tested for PEI with faecal elastase-1 (FE1) were identified and information retrieved from the electronic patient record. PEI was defined as FE1 < 200 μg/g. Patients already taking pancreatic enzyme replacement therapy were excluded. Multiple imputation was used to handle missing data. Univariable logistic regression was used to study which presenting symptoms predicted PEI. Multivariable logistic regression was used to explore the relationship between all previously reported associations and PEI.
RESULTS Of 1027 patients were included. 182 patients (17.7%) were diagnosed with PEI. Steatorrhoea [odds ratios (OR): 2.51, 95% confidence intervals (CI): 1.58-3.98] and weight loss (OR: 1.49, 95%CI: 1.08-2.06) were the only presenting symptoms that predicted PEI. Chronic pancreatitis (OR: 7.98, 95%CI: 3.95-16.15), pancreatic cancer (OR: 6.58, 95%CI: 1.67-25.98), upper GI surgery (OR: 2.62, 95%CI: 1.32-5.19), type 2 diabetes (OR: 1.84, 95%CI: 1.18-2.87), proton pump inhibitor therapy (OR: 1.87, 95%CI: 1.25-2.80) and Asian ethnicity (OR: 2.11, 95%CI: 1.30-3.42) were significantly associated with PEI in the multivariable analysis. None of the other historically reported associations with PEI were significant after adjustment for the other variables included in our multivariable analysis.
CONCLUSION PEI is common in patients with chronic pancreatitis, pancreatic cancer, upper GI surgery and type 2 diabetes. Proton pump inhibitor therapy may also be associated with PEI or a false positive FE1.
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Affiliation(s)
- Benjamin M Shandro
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Joshua Chen
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Jennifer Ritehnia
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
| | - Andrew Poullis
- Department of Gastroenterology, St George's University Hospitals NHS Foundation Trust, London SW17 0QT, United Kingdom
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8
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Anoop S, Dasgupta R, Jebasingh FK, Ramachandran R, Kurian ME, Rebekah G, Balsubramanian KA, Thomas N. Exocrine pancreatic insufficiency related fat malabsorption and its association with autonomic neuropathy in Asian Indians with type 2 diabetes mellitus. Diabetes Metab Syndr 2021; 15:102273. [PMID: 34520998 DOI: 10.1016/j.dsx.2021.102273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS We aimed to estimate the prevalence of exocrine pancreatic insufficiency (EPI) related fat malabsorption & to correlate it with measures of autonomic neuropathy in patients with T2DM from India. METHODS Patients with T2DM (cases; n = 118) and normo-glycaemic individuals (controls; n = 82) underwent anthropometry and biochemical evaluation at baseline. The 72-hours fecal fat excretion was estimated by the Van de Kamer's titration method. Autonomic neuropathy was evaluated using an automated analyzer. RESULTS The prevalence of EPI related fat malabsorption in cases was 45% (n = 53; 72 hours mean fecal fat level = 22.7 ± 5.6 g/day). Dysfunctions in the parasympathetic nervous system (PNS; 86.7%; p < 0.05), sympathetic nervous system (SNS; 92.4%; p < 0.05), and both; PNS + SNS (83.1%; p < 0.05) were significant. Amongst measures of PNS dysfunction, there was a significantly higher percentage of abnormal expiration: inspiration ratio (45.3%) and the 30:15 ratio (84.9%) (p < 0.05) in patients with T2DM and EPI related fat malabsorption. CONCLUSION In this cross-sectional cohort of Asian Indian patients with T2DM (n = 118), EPI related fat malabsorption correlates significantly with autonomic dysfunction in patients with T2DM. However, these preliminary data need to confirmed in trials with more robust design.
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Affiliation(s)
- Shajith Anoop
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Riddhi Dasgupta
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Felix K Jebasingh
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Roshna Ramachandran
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | | | - Grace Rebekah
- Department of Biostatistics, Christian Medical College, Vellore, India
| | - K A Balsubramanian
- Division of Gastrointestinal Sciences, Wellcome Research Laboratory, Christian Medical College, Vellore, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India.
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9
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Appetite and Nutritional Status as Potential Management Targets in Patients with Heart Failure with Reduced Ejection Fraction-The Relationship between Echocardiographic and Biochemical Parameters and Appetite. J Pers Med 2021; 11:jpm11070639. [PMID: 34357106 PMCID: PMC8307226 DOI: 10.3390/jpm11070639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/24/2022] Open
Abstract
This study aimed to investigate the role of appetite loss and malnutrition in patients with heart failure with reduced ejection fraction (HFrEF). In this prospective, observational, single-center study, we enrolled 120 consecutive adults with HFrEF. We analyzed the selected clinical, echocardiographic, and biochemical parameters. Appetite loss and malnutrition were assessed by CNAQ (Council on Nutrition Appetite Questionnaire) and MNA (Mini Nutritional Assessment)/GNRI (Geriatric Nutritional Risk Index) questionnaires, respectively.Most patients were men (81.7%), mean age was 55.1 ± 11.3 years, and mean left ventricular ejection fraction was 23.9 ± 8.0%. The mean CNAQ score was 28.8 ± 3.9, mean MNA-23.1 ± 2.6, and mean GNRI-113.0 ± 12.3. Based on ROC curves, we showed that a sodium concentration <138 mmol/L had the greatest discriminating power for diagnosing impaired nutritional status (MNA ≤ 23.5) with a sensitivity of 54.5% and specificity of 77.8%. The threshold of HDL <0.97 mmol/L characterized 40.7% sensitivity and 86% specificity, B-type natriuretic peptide >738.6 pg/dL had 48.5% sensitivity and 80.8% specificity, high-sensitivity C-reactive protein >1.8 mg/L had 94.9% sensitivity and 42.9% specificity, and bilirubin >15 µmol/L had 78.2% sensitivity and 56.9% specificity. Nutritional status and appetite assessed by MNA/GNRI and CNAQ questionnaires showed poor correlations with other findings in HFrEF patients.
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Nikolic S, Dugic A, Steiner C, Tsolakis AV, Haugen Löfman IM, Löhr JM, Vujasinovic M. Chronic pancreatitis and the heart disease: Still terra incognita? World J Gastroenterol 2019; 25:6561-6570. [PMID: 31802835 PMCID: PMC6886015 DOI: 10.3748/wjg.v25.i44.6561] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/08/2019] [Accepted: 11/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It 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.
AIM To explore the evidence regarding the association of CP and heart disease, more specifically CVD and CHF.
METHODS A 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.
RESULTS Out 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.
CONCLUSION Current 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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Affiliation(s)
- Sara Nikolic
- Department of Medicine Huddinge, Karolinska Institute, Stockholm 14183, Sweden
- Department of Gastroenterology, Division of Internal Medicine, University Medical Centre Maribor, Maribor 2000, Slovenia
| | - Ana Dugic
- Department of Medicine, Klinikum Bayreuth, Bayreuth 95445, Germany
| | - Corinna Steiner
- Department for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
| | - Apostolos V Tsolakis
- Department for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Oncology and Pathology, Karolinska Institute, Stockholm 17176, Sweden
- Cancer Centre Karolinska, CCK, Karolinska University Hospital, Stockholm 17176, Sweden
| | - Ida Marie Haugen Löfman
- Unit of Cardiology, Heart and Vascular Theme, Karolinska University Hospital Huddinge, Stockholm 14186, Sweden
- Department of Medicine Solna, Karolinska Institute, Stockholm 17176, Sweden
| | - J-Matthias Löhr
- Department for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institute, Stockholm 17176, Sweden
| | - Miroslav Vujasinovic
- Department of Medicine Huddinge, Karolinska Institute, Stockholm 14183, Sweden
- Department for Digestive Diseases, Karolinska University Hospital, Stockholm 14186, Sweden
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Capurso G, Traini M, Piciucchi M, Signoretti M, Arcidiacono PG. Exocrine pancreatic insufficiency: prevalence, diagnosis, and management. Clin Exp Gastroenterol 2019; 12:129-139. [PMID: 30962702 PMCID: PMC6432881 DOI: 10.2147/ceg.s168266] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Exocrine pancreatic insufficiency (EPI) is a condition caused by reduced or inappropriate secretion or activity of pancreatic juice and its digestive enzymes, pancreatic lipase in particular. EPI can result in clinical manifestation and biochemical alterations causing reduced quality of life and life-threating complications. EPI is common in pancreatic disorders, where it should be suspected and actively investigated, and in many extrapancreatic conditions. There are various tests available to diagnose EPI, with indirect, noninvasive ones, such as concentration of fecal elastase being more commonly employed. Administration of pancreatic enzymes replacement therapy remains the mainstay of EPI treatment. The present review article will discuss current evidence regarding the prevalence of EPI, the available tests to diagnose it and its treatment.
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Affiliation(s)
- Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy,
| | - Mariaemilia Traini
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy,
| | - Matteo Piciucchi
- Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Marianna Signoretti
- Digestive and Liver Disease Unit, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Centre, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy,
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