Cardiac cachexia: hic et nunc

Abstract

Cardiac cachexia (CC) is the clinical entity at the end of the chronic natural course of heart failure (HF). Despite the efforts, even the most recent definition of cardiac cachexia has been challenged, more precisely, the addition of new criteria on top of obligatory weight loss. The pathophysiology of CC is complex and multifactorial. A better understanding of pathophysiological pathways in body wasting will contribute to establish potentially novel treatment strategies. The complex biochemical network related with CC and HF pathophysiology underlines that a single biomarker cannot reflect all of the features of the disease. Biomarkers that could pick up the changes in body composition before they convey into clinical manifestations of CC would be of great importance. The development of preventive and therapeutic strategies against cachexia, sarcopenia, and wasting disorders is perceived as an urgent need by healthcare professionals. The treatment of body wasting remains an unresolved challenge to this day. As CC is a multifactorial disorder, it is unlikely that any single agent will be completely effective in treating this condition. Among all investigated therapeutic strategies, aerobic exercise training in HF patients is the most proved to counteract skeletal muscle wasting and is recommended by treatment guidelines for HF.

Impact of Plasma Kynurenine Level on Functional Capacity and Outcome in Heart Failure ― Results From Studies Investigating Co-morbidities Aggravating Heart Failure (SICA-HF) ―

“…33 In the present study, kynurenine was associated with CRP, as were some metabolites of the kynurenine pathway in previous studies. 30 Given that inflammation is associated with muscle dysfunction 34, 35 and reduced functional capacity, 36 inflammation may be a common background both for higher kynurenine and impaired functional capacity observed in the present study. Kynurenine is an endothelium-derived relaxing factor 37 and may also be produced as a feedback mechanism to counteract vasoconstriction, 21,38 which is frequently observed and measured as elevated systemic vascular resistance in right heart catheterization in patients with HF.…”

Muscle wasting and sarcopenia in heart failure: a brief overview of the current literature

“…34 In patients with dilated cardiomyopathy, an even higher prevalence has been established. 40,41 As discussed earlier, the clinical definition of sarcopenia remains a matter of debate, and a number of screening tools have been developed. Patients with muscle wasting had lower left ventricular ejection fraction, lower 6 min walk distance, and a higher New York Heart Association functional class and hospitalization rate.…”

MicroRNAs in muscle wasting

“…[17][18][19][20][21] Several other circulating factors like GDF-15, 22 activin A, 23 and low testosterone 24 have been associated with muscle loss and survival in sarcopenia and cachexia and therefore can be considered potential biomarkers, but need to be validated in large trials. 1 This is of particular importance in muscle wasting, as there are very few blood-based biomarkers such as myostatin or agrinin that correlated with muscle mass.…”