Acute heart failure (AHF) is frequently accompanied by end-organ dysfunction related to congestion and impaired perfusion. An analysis from the AVANTI trial presented at the Heart Failure 2026 evaluated whether pancreatic involvement may also occur during AHF by examining changes in serum lipase levels during and after hospitalization.

The study included 480 patients enrolled in the AVANTI AHF trial, with serum lipase measured at baseline (day 1), day 7, and day 30. Longitudinal enzyme trajectories were analyzed using linear mixed models and compared with simultaneously measured hepatic biomarkers, including alanine aminotransferase (ALT), aspartate aminotransferase (AST), and gamma-glutamyl transferase (GGT).

Findings

• Serum lipase increased modestly but significantly from day 1 to day 7 by 1 U/L (interquartile range -6 to 10; p=0.011).
• Lipase levels subsequently declined slightly between day 7 and day 30 by -2 U/L (interquartile range -11 to 6; p=0.002).
• ALT and AST also increased modestly between day 1 and day 7 before decreasing thereafter.
• GGT remained stable initially and declined between day 7 and day 30.
• Patients in the highest NT-proBNP quartile had higher lipase levels than those in the lowest quartile: 40 (30–55) U/L vs 35 (25–54) U/L (p=0.040).
• Patients in the highest lipase quartile also demonstrated higher AST and GGT levels compared with the lowest quartile (both p<0.001).

In this AVANTI trial analysis, patients hospitalized with acute heart failure demonstrated small but significant transient increases in serum lipase