Post-prandial acyl ghrelin infusion in heart failure patients increases gastric emptying rate

Acyl ghrelin increases cardiac output (CO) and contractility in patients with heart failure with reduced ejection fraction (HFrEF). In healthy humans, acyl ghrelin increases gastric emptying rate (GER) and hunger, a potential add-on benefit for HFrEF patients suffering from cachexia with symptoms of delayed gastric emptying and loss of appetite. The aim of this study was to determine if post-prandial acyl ghrelin infusion increases GER and hunger in HFrEF patients compared to CO. HFrEF patients (n = 29) arrived fasted and received a 500-kcal breakfast followed by 1.5 g paracetamol. They next received placebo (vehicle, n = 15) or acyl ghrelin infusion (0.1 µg/kg/min, n = 14) for 120 min. Blood was tapped for plasma at 0, 30, 60, 120, and 150 min into the meal. Hunger scores and CO were recorded. Plasma paracetamol was measured to assess GER. Paracetamol concentration peaked at 30 min in 8 of 14 (57%) in the treatment group versus 1 of 15 (7%) in the placebo group (Mann-Whitney test, P = 0.004). Remaining patients peaked at later time points. The acyl ghrelin treatment group data was segregated into rapid (peak at 30 min, n = 8) and slow (peak > 30 min, n = 6) GER sub-groups. The rapid sub-group had an acyl ghrelin treatment effect on CO (one-way repeat measures, P < 0.001) and the highest median increase in hunger across all time points. Acyl ghrelin increases GER and in tandem with increasing CO. Effects on hunger are more difficult to resolve due to variability in subjective scores. Some HFrEF patients may benefit from this add-on effect.