Miroslava Valentova1, Stephan von Haehling2, Juergen Bauditz3, Wolfram Doehner4, Nicole Ebner5, Tarek Bekfani6, Sebastian Elsner6, Veronika Sliziuk6, Nadja Scherbakov6, Ján Murín7, Stefan D Anker2, Anja Sandek8. 1. Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany First Department of Internal Medicine, Comenius University, Bratislava, Slovakia miroslava.valentova@med.uni-goettingen.de. 2. Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany. 3. Department of Gastroenterology, Charité Medical School, Campus Mitte, Berlin, Germany Center for Internal Medicine, Helios Clinic Zerbst/Anhalt, Zerbst, Germany. 4. Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany. 5. Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany. 6. Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany. 7. First Department of Internal Medicine, Comenius University, Bratislava, Slovakia. 8. Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany.
Abstract
AIMS: Mechanisms leading to cachexia in heart failure (HF) are not fully understood. We evaluated signs of intestinal congestion in patients with chronic HF and their relationship with cachexia. METHODS AND RESULTS: Of the 165 prospectively enrolled outpatients with left ventricular ejection fraction ≤40%, 29 (18%) were cachectic. Among echocardiographic parameters, the combination of right ventricular dysfunction and elevated right atrial pressure (RAP) provided the best discrimination between cachectic and non-cachectic patients [area under the curve 0.892, 95% confidence interval (CI): 0.832-0.936]. Cachectic patients, compared with non-cachectic, had higher prevalence of postprandial fullness, appetite loss, and abdominal discomfort. Abdominal ultrasound showed a larger bowel wall thickness (BWT) in the entire colon and terminal ileum in cachectic than in non-cachectic patients. Bowel wall thickness correlated positively with gastrointestinal symptoms, high-sensitivity C-reactive protein, RAP, and truncal fat-free mass, the latter serving as a marker of the fluid content. Logistic regression analysis showed that BWT was associated with cachexia, even after adjusting for cardiac function, inflammation, and stages of HF (odds ratio 1.4, 95% CI: 1.0-1.8; P-value = 0.03). Among the cardiac parameters, only RAP remained significantly associated with cachexia after multivariable adjustment. CONCLUSION: Cardiac cachexia was associated with intestinal congestion irrespective of HF stage and cardiac function. Gastrointestinal discomfort, appetite loss, and pro-inflammatory activation provide probable mechanisms, by which intestinal congestion may trigger cardiac cachexia. However, our results are preliminary and larger studies are needed to clarify the intrinsic nature of this relationship. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: Mechanisms leading to cachexia in heart failure (HF) are not fully understood. We evaluated signs of intestinal congestion in patients with chronic HF and their relationship with cachexia. METHODS AND RESULTS: Of the 165 prospectively enrolled outpatients with left ventricular ejection fraction ≤40%, 29 (18%) were cachectic. Among echocardiographic parameters, the combination of right ventricular dysfunction and elevated right atrial pressure (RAP) provided the best discrimination between cachectic and non-cachectic patients [area under the curve 0.892, 95% confidence interval (CI): 0.832-0.936]. Cachectic patients, compared with non-cachectic, had higher prevalence of postprandial fullness, appetite loss, and abdominal discomfort. Abdominal ultrasound showed a larger bowel wall thickness (BWT) in the entire colon and terminal ileum in cachectic than in non-cachectic patients. Bowel wall thickness correlated positively with gastrointestinal symptoms, high-sensitivity C-reactive protein, RAP, and truncal fat-free mass, the latter serving as a marker of the fluid content. Logistic regression analysis showed that BWT was associated with cachexia, even after adjusting for cardiac function, inflammation, and stages of HF (odds ratio 1.4, 95% CI: 1.0-1.8; P-value = 0.03). Among the cardiac parameters, only RAP remained significantly associated with cachexia after multivariable adjustment. CONCLUSION:Cardiac cachexia was associated with intestinal congestion irrespective of HF stage and cardiac function. Gastrointestinal discomfort, appetite loss, and pro-inflammatory activation provide probable mechanisms, by which intestinal congestion may trigger cardiac cachexia. However, our results are preliminary and larger studies are needed to clarify the intrinsic nature of this relationship. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Laura M Lesnewich; Fiona N Conway; Jennifer F Buckman; Christopher J Brush; Peter J Ehmann; David Eddie; Ryan L Olson; Brandon L Alderman; Marsha E Bates Journal: Int J Psychophysiol Date: 2019-06-10 Impact factor: 2.997
Authors: Nils P Nickel; Ke Yuan; Peter Dorfmuller; Steeve Provencher; Yen-Chun Lai; Sebastien Bonnet; Eric D Austin; Carl D Koch; Alison Morris; Frédéric Perros; David Montani; Roham T Zamanian; Vinicio A de Jesus Perez Journal: Am J Respir Crit Care Med Date: 2020-01-15 Impact factor: 21.405
Authors: Veli-Pekka Harjola; Wilfried Mullens; Marek Banaszewski; Johann Bauersachs; Hans-Peter Brunner-La Rocca; Ovidiu Chioncel; Sean P Collins; Wolfram Doehner; Gerasimos S Filippatos; Andreas J Flammer; Valentin Fuhrmann; Mitja Lainscak; Johan Lassus; Matthieu Legrand; Josep Masip; Christian Mueller; Zoltán Papp; John Parissis; Elke Platz; Alain Rudiger; Frank Ruschitzka; Andreas Schäfer; Petar M Seferovic; Hadi Skouri; Mehmet Birhan Yilmaz; Alexandre Mebazaa Journal: Eur J Heart Fail Date: 2017-05-30 Impact factor: 15.534
Authors: Stephan von Haehling; Nicole Ebner; Marcelo R Dos Santos; Jochen Springer; Stefan D Anker Journal: Nat Rev Cardiol Date: 2017-04-24 Impact factor: 32.419
Authors: Joerg C Schefold; Gerasimos Filippatos; Gerd Hasenfuss; Stefan D Anker; Stephan von Haehling Journal: Nat Rev Nephrol Date: 2016-08-30 Impact factor: 28.314