Effect of a Meal on Invasive Hemodynamics and Plasma Incretin Levels in Patients With Heart Failure

BACKGROUND: The importance of gastrointestinal hormones, including the incretins glucagon-like peptide-1 (GLP-1) and GIP (glucose-dependent insulinotropic polypeptide), in heart failure pathophysiology is debated. The postprandial incretin response and its relation to hemodynamic changes in patients with heart failure, however, remains unknown. METHODS: A pulmonary artery catheter was placed in 14 patients with chronic heart failure and 10 healthy controls, who subsequently consumed a standardized meal (3.2 MJ). Hemodynamic measures and blood samples were collected over 120 minutes. Bowel wall thickness and superior mesenteric artery blood flow were measured by ultrasound. Gastrointestinal symptoms were assessed through questionnaires. RESULTS: Patients, compared with controls, exhibited an impaired postprandial peak in cardiac index (2.8 versus 4.0 L/min per m^2, P<0.001) and a blunted cardiac index response in the postprandial period (baseline-substracted area under the curve, P=0.030). Patients had higher fasting total GLP-1 levels (14.0 versus 7.5 pmol/L, P=0.015) and a greater postprandial peak (33.5 versus 21.0 pmol/L, P=0.013). Fasting total GLP-1 concentrations correlated with central venous pressure (P=0.025). There was a trend toward a correlation between area under the curve total GLP-1 and cardiac index (P=0.054). There was no change in GIP concentrations. Patients had a higher gastrointestinal symptom burden (P=0.033), and an indigestion score that correlated with peak superior mesenteric artery blood flow (P=0.017). CONCLUSIONS: Patients with heart failure showed a blunted cardiac index response to meal intake, elevated total GLP-1 levels that were associated with hemodynamic parameters, and increased gastrointestinal symptom burden.