Exocrine pancreatic insufficiency in the setting of chronic heart failure with reduced ejection fraction: mechanisms of development and approaches to their correction. Review

The aim of this review is to discuss the available evidence on the mechanisms of development of exocrine pancreatic insufficiency in chronic heart failure with reduced ejection fraction, their clinical consequences and modern ways of correction. The results of modern studies have demonstrated a high prevalence of atrophy of the pancreatic parenchyma and its replacement by fibrous tissue among patients with chronic heart failure with reduced ejection fraction, which is accompanied by the development of exocrine pancreatic insufficiency. In addition, the presence of a large number of adrenergic receptors and all components of the renin‑angiotensin‑aldosterone system in the vascular network of the pancreas has been proven, as well as a significant dependence of pancreatic function on the tone of the parasympathetic nervous system, which contributes to pancreatic ischemia and dysfunction of acinar cells responsible for the production of enzymes in chronic heart failure with reduced ejection fraction. Common consequences of exocrine pancreatic insufficiency are malabsorption syndrome and associated deficiencies of amino acids, fat‑soluble vitamins A, D, E, and K, minerals such as magnesium, calcium, and zinc, as well as hypoproteinemia, sarcopenia, osteoporosis, decreased immunity. Malabsorption syndrome contributes to the progression of metabolic and structural remodeling of the myocardium, decompensation of chronic heart failure, and significantly increases the risk of hospitalization and mortality. Based on the results of the literature review, it was concluded that timely detection and adequate treatment of chronic heart failure with reduced ejection fraction, as well as early diagnosis of exocrine pancreatic insufficiency by fecal elastase‑1 levels, screening for nutritional deficiencies, and the appointment of adequate enzyme replacement therapy and supplements to correct the levels of essential nutrients play a leading role in the prevention and treatment of exocrine pancreatic insufficiency in chronic heart failure with reduced ejection fraction.