Acyl ghrelin in heart failure treatment shows promising results beyond simple hemodynamics. Recent evidence suggests that this hormone improves gastric motility and appetite in patients with heart failure with reduced ejection fraction (HFrEF). This dual benefit is crucial because many advanced heart failure patients suffer from cardiac cachexia, a condition involving severe weight loss and muscle wasting. By addressing both cardiac performance and nutritional intake, acyl ghrelin offers a comprehensive therapeutic strategy.

A recent study by Webb DL and colleagues explored these effects through post-prandial infusions. Specifically, researchers evaluated the gastric emptying rate (GER) using a paracetamol absorption test in 29 HFrEF patients. The participants received either a placebo or an infusion of acyl ghrelin at a dose of 0.1 µg/kg/min. Consequently, the results were striking. Paracetamol concentrations peaked at 30 minutes in 57% of the treatment group, compared to only 7% of the placebo group. This indicates a significant acceleration in how quickly the stomach clears its contents after a meal.

Improving Gastric Emptying Rate with Acyl Ghrelin in Heart Failure

Furthermore, the study identified a meaningful connection between rapid gastric emptying and improved cardiac function. Specifically, the sub-group of patients who showed rapid gastric emptying also experienced a significant increase in cardiac output. This suggests that the metabolic and hemodynamic effects of acyl ghrelin are synergistic. Additionally, hunger scores showed a gradual increase during the treatment period. Although the results did not reach full statistical significance, the trend clearly favored the acyl ghrelin group, particularly in those with potent gastric responses.

Moreover, these findings highlight the potential for acyl ghrelin to manage the symptoms of delayed gastric emptying and loss of appetite. These issues often lead to poor prognosis and reduced quality of life in heart failure. Therefore, clinicians should consider the broader metabolic impact of new therapies like ghrelin analogues. Future research will likely focus on long-term administration to see if these improvements translate into sustained weight gain and better clinical outcomes.

What is the clinical significance of faster gastric emptying in heart failure?

Many patients with advanced heart failure suffer from cardiac cachexia, which includes delayed gastric emptying and loss of appetite. Faster gastric emptying can improve nutritional intake, alleviate gastrointestinal distress, and enhance overall quality of life for these patients.

How does acyl ghrelin influence cardiac output?

Acyl ghrelin acts as a positive inotrope. It increases cardiac contractility and stroke volume without causing the tachycardia or arrhythmias often associated with traditional inotropic medications.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or substitute for professional consultation. Refer to the latest local and national guidelines for clinical practice.

References

Webb DL et al. Post-prandial acyl ghrelin infusion in heart failure patients increases gastric emptying rate. Naunyn Schmiedebergs Arch Pharmacol. 2026 Mar 26. doi: 10.1007/s00210-026-05245-5. PMID: 41886075.

Lund LH et al. Acyl ghrelin improves cardiac function in heart failure and increases fractional shortening in cardiomyocytes without calcium mobilization. Eur Heart J. 2023 Mar 14;44(11):970-981. doi: 10.1093/eurheartj/ehad100.

Erhardsson M et al. Acyl ghrelin increases cardiac output while preserving right ventricular-pulmonary arterial coupling in heart failure. JACC Heart Fail. 2024 Feb;12(2):315-325. doi: 10.1016/j.jchf.2023.09.022.