The complex pathophysiology of cardiac cachexia: A review of current pathophysiology and implications for clinical practice

Thanapholsart, Jenjiratchaya; Khan, E.U.; Ismail, Tevfik F; Lee, Geraldine

doi:10.1016/j.amjms.2022.08.016

Cited by 9 publications

(10 citation statements)

References 110 publications

(92 reference statements)

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“…The pathophysiology of malnutrition in patients with heart failure is not clear. The underlying pathophysiological mechanism between malnutrition and heart failure can be explained in two ways [20,21]. One is that fluid retention leads to intestinal edema, nausea, anorexia, and other symptoms, affecting the intake and absorption of nutrients.…”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of controlling nutritional status in older adults with heart failure with preserved ejection fraction: a prospective comparative study with other objective nutritional indices

Chen

Zheng

2023

Aging Clin Exp Res

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Objective We explored the prognostic significance of controlling nutritional status (CONUT) score in older adults with heart failure with preserved ejection fraction (HFpEF) and compared CONUT with other objective nutritional indices. Methods This is a single-center retrospective cohort study in older adult coronary artery disease patients undergoing HFpEF. Clinical data and laboratory results were collected before discharge. CONUT, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI) were calculated according to the formula. The primary endpoint of this study was readmission due to heart failure and all-cause mortality in the first year after hospitalization. Results A total of 371 older adults were enrolled. All patients were discharged and followed up for 1 year, and readmission for heart failure was 26% while all-cause mortality was 20%. Compared with the none and mild malnutrition risk group, the readmission rate for heart failure (HF) within 1 year (36% vs. 18%, 23%) and all-cause mortality rate in the moderate and severe malnutrition risk group (40% vs. 8%, 0%) were higher (P < 0.05). On multivariate logistic analysis, CONUT was not associated with readmission due to HF within 1 year. CONUT was significantly associated with all-cause mortality independently of GNRI or PNI, after adjustment for major confounders including age, bedridden; length of stay; history of chronic kidney disease; loop diuretics use; angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and beta-adrenergic blocking agents use; New York Heart Association (NYHA) functional class; hemoglobin; potassium; Creatinine; triglycerides; glycosylated hemoglobin; brain natriuretic peptide; left ventricular ejection fraction; GNRI and PNI via multivariable Cox analysis (HR (95% CI) 1.764 (1.503, 2.071); 1.646 (1.359, 1.992); 1.764 (1.503, 2.071), respectively). Kaplan–Meier analysis revealed that the risk of all-cause mortality significantly increased in accordance with a higher CONUT (CONUT 5–12 compare to 0–1:HR (95% CI) 6.16 (3.78, 10.06); CONUT 2–4 compare to 0–1:HR (95% CI) 0.16 (0.10, 0.26)). CONUT showed the best area under the curve value (0.789) for the prediction of all-cause mortality compared with the other objective nutritional indices. Conclusion CONUT is a simple and strong prognostic indicator for the prediction of all-cause mortality in older adults with HFpEF. Clinical Trials.gov Identifier NCT05586828.

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Section: Discussionmentioning

confidence: 99%

Prognostic significance of controlling nutritional status in older adults with heart failure with preserved ejection fraction: a prospective comparative study with other objective nutritional indices

Chen

Zheng

2023

Aging Clin Exp Res

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“…[39][40][41][42][43] This possibility is supported by several studies implicating sympathetic traffic in heart failure-associated cachexia caused by excess loss of adiposity. 44,45 Remarkably, a prospective study identified muscle sympathetic nerve activity as the most sensitive marker of weight loss in heart failure patients. 46 Moreover, heart failure patients treated with β-blockers displayed a lower incidence of cachexia, and better outcomes.…”

Section: Vascular Effects On Metabolismmentioning

confidence: 99%

Neural Circuits Underlying Reciprocal Cardiometabolic Crosstalk: 2023 Arthur C. Corcoran Memorial Lecture

Rahmouni

2024

Hypertension

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The interplay of various body systems, encompassing those that govern cardiovascular and metabolic functions, has evolved alongside the development of multicellular organisms. This evolutionary process is essential for the coordination and maintenance of homeostasis and overall health by facilitating the adaptation of the organism to internal and external cues. Disruption of these complex interactions contributes to the development and progression of pathologies that involve multiple organs. Obesity-associated cardiovascular risks, such as hypertension, highlight the significant influence that metabolic processes exert on the cardiovascular system. This cardiometabolic communication is reciprocal, as indicated by substantial evidence pointing to the ability of the cardiovascular system to affect metabolic processes, with pathophysiological implications in disease conditions. In this review, I outline the bidirectional nature of the cardiometabolic interaction, with special emphasis on the impact that metabolic organs have on the cardiovascular system. I also discuss the contribution of the neural circuits and autonomic nervous system in mediating the crosstalk between cardiovascular and metabolic functions in health and disease, along with the molecular mechanisms involved.

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“…In experimental models of cancer cachexia heart function is reduced, with evidence of cardiac fibrosis, altered myocardial structure and a reduction in cardiac myofibrillar proteins observed [36,37]. The cardiac dysfunction caused by cancer cachexia may lead to further a cascade of muscle wasting, as patients with chronic heart failure can develop cardiac cachexia, a syndrome which has some mechanistic overlap with cancer cachexia [38].…”

Section: Heartmentioning

confidence: 99%

“…The cardiac dysfunction caused by cancer cachexia may lead to further a cascade of muscle wasting, as patients with chronic heart failure can develop cardiac cachexia, a syndrome which has some mechanistic overlap with cancer cachexia [38].…”

Section: Cachexia As a Multisystem Disordermentioning

confidence: 99%

Cancer cachexia – adopting a systems wide approach

Sayers

Skipworth

Laird

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of reviewCancer cachexia results in the death of approximately 2 million people worldwide annually. Despite the impact of this devastating condition, there is limited therapy and no standard of care. Although multiple definitions exist, confusion remains as a true understanding of the biology has not yet been achieved and distinct phases of cachexia have not been examined. Research has mainly focused on weight loss and muscle wasting, but cachexia is increasingly recognized as a multiorgan disorder involving adipose tissue, liver, brain, gut and heart, with systemic inflammation a central unifying feature.Recent findingsIn this review, we will discuss some of the extra-muscular features and multisystem interactions in cachexia, and describe how moving our focus beyond muscle can lead to a greater understanding of the mechanisms and clinical features seen in cachexia.SummaryWe describe the need for robust characterization of patients with cachexia, to allow clinical phenotypes and multisystem mechanisms to be untangled, and to enable the implementation of multimodal treatment strategies.

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The complex pathophysiology of cardiac cachexia: A review of current pathophysiology and implications for clinical practice

Cited by 9 publications

References 110 publications

Prognostic significance of controlling nutritional status in older adults with heart failure with preserved ejection fraction: a prospective comparative study with other objective nutritional indices

Prognostic significance of controlling nutritional status in older adults with heart failure with preserved ejection fraction: a prospective comparative study with other objective nutritional indices

Neural Circuits Underlying Reciprocal Cardiometabolic Crosstalk: 2023 Arthur C. Corcoran Memorial Lecture

Cancer cachexia – adopting a systems wide approach

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