March 2016

In this study, DZHK researchers led by Miroslava Valentova at the DZHK site in Göttingen showed that congestion of the intestinal tract commonly occurs in patients with heart failure and is particularly pronounced in patients with heart failure-induced weight loss (cardiac cachexia). The team examined the intestinal wall in patients with heart disease using ultrasound imaging. The investigators found that those patients who had unwanted weight loss had thicker intestinal walls – an indication of water retention in the bowel in heart failure. The echocardiographic studies showed that this thickening of the intestinal wall in cardiac cachexia is associated with reduced pumping function, in particular of the right heart. The right heart’s inability to pump the blood along leads to congestion of the venous blood flow to the heart. The study shows for the first time that this congestion is particularly common in patients with unwanted weight loss and that it also affects the gastrointestinal tract. This can have serious effects on intestinal function, ultimately promoting weight loss. For example, in the current study, patients with swelling of the intestinal wall more frequently suffered from loss of appetite and abdominal fullness. Additional mechanisms include reduced nutrient absorption, altered intestinal flora, and easier transfer of intestinal bacteria through the congested intestinal wall, which can lead to weight loss and also promote the progression of heart failure through inflammatory activity. The observed link between congestion in the gastrointestinal tract and progressive weight loss in patients with right-heart failure calls for a stronger focus on the gastrointestinal tract in the research into the pathophysiology of heart failure.

Link to the Paper