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Recent studies have highlighted the close link between the heart, the liver, and the pancreas, which are organically connected via the same inflammatory processes and pathways. Liver congestion and fibrosis are responsible for the inflammatory process and the lack of metabolic adaptation, whereas pancreatic ischaemia and insufficiency of the exocrine glands aggravate malnutrition and cachexia, worsening the heart condition. Acute pancreatitis may cause heart failure and arrhythmia through injury and systemic inflammatory response syndrome (SIRS), an inflammatory process mediated by the cytokines released during the injury process. Recognition of this hepato\u2013pancreato\u2013cardiac axis offers a paradigm shift towards integrated management of HFpEF, emphasizing anti-inflammatory, metabolic, and haemodynamic interventions. Future research integrating multi-organ imaging, inflammatory biomarkers, and therapeutic trials such as GLP-1 receptor agonists, SGLT2 inhibitors, and cytokine blockers will be critical to disrupt this tri-organ inflammatory circuit and improve outcomes in HFpEF.<\/jats:p>","DOI":"10.1093\/eschf\/xvag040","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T12:46:13Z","timestamp":1769690773000},"source":"Crossref","is-referenced-by-count":5,"title":["Heart failure with preserved ejection fraction beyond the heart: exploring the heart\u2013liver\u2013pancreas axis"],"prefix":"10.1093","volume":"13","author":[{"given":"Han Naung","family":"Tun","sequence":"first","affiliation":[{"name":"Geisel School of Medicine at Dartmouth , Hanover, NH ,","place":["USA"]},{"name":"Bouve College of Health Sciences, Northeastern University , Boston, MA 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