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The cardiac component of cardiac cachexia
Viorel G Florea1, Michael Y Henein, Mathias Rauchhaus
1Department of Cardiac Medicine, National Heart and Lung Institute, London, United Kingdom. flore022@tc.umn.edu
Insights
Cardiac cachexia involves significant left ventricular (LV) mass loss over time, more frequently observed in cachectic patients with chronic heart failure. Echocardiography revealed no cross-sectional differences, but longitudinal analysis showed distinct LV mass changes.
Area of Science:
- Cardiology
- Heart Failure Research
- Cachexia Studies
Background:
- Emerging evidence highlights noncardiac factors in cardiac cachexia.
- The specific role of the heart in this syndrome requires further investigation.
- This study examines cardiac structure and function in chronic heart failure with and without cachexia.
Purpose of the Study:
- To assess cardiac dimensions, mass, and function in patients with chronic heart failure.
- To evaluate changes in these cardiac parameters over time in cachectic versus non-cachectic patients.
- To determine the cardiac contribution to the syndrome of cardiac cachexia.
Main Methods:
- Doppler echocardiography was employed in 28 cachectic and 56 non-cachectic patients with chronic heart failure.
- Matched patient groups were compared based on nonedematous weight loss.
- Longitudinal analysis of left ventricular (LV) dimensions and mass was performed using prior echocardiographic recordings.
Main Results:
- Cross-sectional echocardiography showed no significant differences in cardiac dimensions or function between cachectic and non-cachectic groups.
- Longitudinal analysis revealed a significant decrease in LV mass (>20%) more frequently in cachectic patients (50%) compared to non-cachectic patients (23%).
- Conversely, an increase in LV mass (>20%) was more common in non-cachectic patients (40%) than in cachectic patients (11%).
Conclusions:
- No distinct echocardiographic cardiac abnormalities were identified in cachectic patients versus non-cachectic patients with chronic heart failure at a single time point.
- Over time, a significant loss of left ventricular (LV) mass occurs more frequently in patients experiencing cardiac cachexia.
- These findings suggest a dynamic cardiac remodeling process contributing to cardiac cachexia.
Background:
Recent evidence suggests the importance of noncardiac mechanisms in the genesis of the syndrome of cardiac cachexia. This raises the question of the relative role of the heart itself in this syndrome. This study sought to assess the cardiac dimensions, mass, and function and changes in these parameters over time in patients with chronic heart failure with and without cachexia.
Methods:
Doppler echocardiography was performed in 28 patients with nonedematous weight loss (>7.5% over a period of >6 months) compared with 56 matched patients without weight loss in a ratio of 1:2 (age 71 +/- 13 vs 67 +/- 8 years, P =.07; New York Heart Association class 2.9 +/- 0.7 vs 2.6 +/- 0.6, P =.08). In 18 cachectic and 35 noncachectic patients with previous echocardiographic recordings, we analyzed the changes in left ventricular (LV) dimensions and mass over time.
Results:
Cardiac dimensions including LV diastolic (69 +/- 9 mm vs 67 +/- 13 mm) and systolic cavity diameter (58 +/- 11 mm vs 55 +/- 15 mm), LV mass (480 +/- 180 g vs 495 +/- 190 g), and LV systolic and diastolic function including fractional shortening (16% +/- 10% vs 18% +/- 10%), isovolumic relaxation time (29 +/- 22 ms vs 36 +/- 27 ms), and E/A ratio (2.7 +/- 1.6 vs 3.3 +/- 2.9) did not differ between cachectic and noncachectic patients (all P >.1). By analyzing changes in LV mass over time, we found an increase (>20%) in 2 (11%) cachectic and 14 (40%) noncachectic patients and a decrease in LV mass (>20%) in 9 (50%) cachectic and 8 (23%) noncachectic patients (chi2 test, P <.05).
Conclusions:
Although no specific cardiac abnormality could be detected echocardiographically in cachectic patients compared with patients with noncachectic chronic heart failure in a cross-sectional study, over time a significant loss of LV mass (>20%) occurs more frequently in patients with cardiac cachexia.