Hormonal Changes and Catabolic/Anabolic Imbalance in Chronic Heart Failure and Their Importance for Cardiac Cachexia

Anker, Stefan D.; Chua, Tuan Peng; Ponikowski, Piotr; Harrington, Derek; Swan, J; Kox, Wolfgang J.; Poole‐Wilson, Philip A.; Coats, Andrew J.S.

doi:10.1161/01.cir.96.2.526

Cited by 727 publications

(464 citation statements)

References 26 publications

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“…The magnitude of neurohormonal activation is equivalent to that found in CHF with good concordance between NYHA class in the 2 populations. 2,27 Neurohormone levels were found to increase in a stepwise manner across functional class, with even patients with asymptomatic disease having significantly elevated levels of ANP, BNP, ET-1, and norepinephrine compared with controls. Anatomic group again did not distinguish between patients with differing degrees of neurohormonal activation, a finding consistent with that of Ross et al, 28 who reported that infants and children (mean age, 3.3 years) with congenital heart disease and severe congestive heart failure had elevated plasma norepinephrine levels regardless of etiology.…”

Section: Discussionmentioning

confidence: 99%

Neurohormonal Activation and the Chronic Heart Failure Syndrome in Adults With Congenital Heart Disease

et al. 2002

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Background — Neurohormonal activation characterizes chronic heart failure, relates to outcome, and is a therapeutic target. It is not known whether a similar pattern of neurohormonal activation exists in adults with congenital heart disease and, if so, whether it relates to common measures of disease severity or whether cardiac anatomy is a better discriminant. Methods and Results — Concentrations of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), endothelin-1 (ET-1), renin, aldosterone, norepinephrine, and epinephrine were determined in 53 adults with congenital heart disease, comprising 4 distinct anatomic subgroups (29 female; 33.5±1.5 years of age; New York Heart Association class 2.0±0.1, mean±SEM) and 15 healthy control subjects (8 female; 32.3±1.3 years of age). Systemic ventricular function was graded by a blinded echocardiographer as normal or mildly, moderately, or severely impaired. Adults with congenital heart disease had elevated levels of ANP (56.6 versus 3.1 pmol/L), BNP (35.8 versus 5.7 pmol/L), ET-1 (2.5 versus 0.7 pmol/L, all P <0.0001), renin (147 versus 16.3 pmol/L), norepinephrine (2.2 versus 1.6 pmol/L, both P <0.01) and aldosterone (546 versus 337 pmol/L, P <0.05). There was a highly significant stepwise increase in ANP, BNP, ET-1, and norepinephrine according to New York Heart Association class and systemic ventricular function, with even asymptomatic patients having evidence of significant neurohormonal activation. In contrast, there was no direct relationship between the 4 anatomic subgroups and any of the neurohormones studied. Conclusions — Neurohormonal activation in adult congenital heart disease bears the hallmarks of chronic heart failure, relating to symptom severity and ventricular dysfunction and not necessarily to anatomic substrate. Neurohormonal antagonism across this large and anatomically diverse population should be considered.

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Section: Discussionmentioning

confidence: 99%

Neurohormonal Activation and the Chronic Heart Failure Syndrome in Adults With Congenital Heart Disease

et al. 2002

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“…This altered ratio might be indicated as the "Cancer-related hypercatabolic syndrome, C-RHS" that is characterized by significant changes in both the muscular and global visceral protein metabolism [14,15]. Interestingly, the continuous turnover of proteins is a process at the root of cell life in healthy individuals.…”

Section: Muscle and Visceral Proteins As A Protein/nitrogen Reservoirmentioning

confidence: 99%

Nutrition, Nitrogen Requirements, Exercise and Chemotherapy-Induced Toxicity in Cancer Patients. A puzzle of Contrasting Truths?

Flati¹,

Corsetti²,

Pasini³

et al. 2015

ACAMC

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Amino acids can modulate cell metabolism and control cell fate by regulating cell survival and cell death. The molecular mechanisms involved are mediated by the mTOR complexes mTORC1 and mTORC2 activity. These complexes are finely regulated and the continuous advancement of the knowledge on their composition and function is revealing that their balance may represent the condition that determines the cell fate. This is important for normal healthy cells but it is becoming clear, and it is even more important, that the balance of the mTORCs activity may also condition the cell fate of cancer cells. Here, we discuss the evidences supporting the amino acids supplementation as a cancer fighting weapon and a possible strategy to counteract the myocyte toxicity associated with chemotherapy, possibly by tipping the balance of mTORCs activity.

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“…10 A caquexia é uma condição resultante de várias doenças sistêmicas como o câncer, a síndrome da imunodeficiência adquirida (AIDS), o diabetes mellitus, a sepsis e a insuficiência renal. 11,12 Pacientes portadores de insuficiência cardíaca que manifestam o quadro de caquexia normalmente apresentam perda excessiva de massa corporal associada à perda de massa óssea, gorda e muscular, além de apresentarem mortalidade aumentada.…”

Section: Introductionunclassified

“…11,12 Pacientes portadores de insuficiência cardíaca que manifestam o quadro de caquexia normalmente apresentam perda excessiva de massa corporal associada à perda de massa óssea, gorda e muscular, além de apresentarem mortalidade aumentada. 10 O mecanismo pelo qual essa redução na massa muscular esquelética eleva os índices de mortalidade, no entanto, não é conhecido. Segundo Anker et al 13 , por exemplo, a área média do quadríceps de pacientes com insuficiência cardíaca caquéticos foi 45,9cm 2 , contra 61,6 cm 2 dos não caquéticos.…”

Section: Introductionunclassified

Relevância e tratamento das lesões características da insuficiência cardíaca na musculatura esquelética

Júnior

2009

Medicina (Ribeirão Preto)

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Pacientes com insuficiência cardíaca, a via final das doenças cardiovasculares e a primeira causa de internação em idosos no Brasil, apresentam deterioração do tecido muscular esquelético. Além disso, as lesões na musculatura têm relação direta com a qualidade de vida e a autonomia dos pacientes, por meio do nível de tolerância aos esforços físicos, além de constituírem um preditor independente de mortalidade na síndrome. Ao longo da presente revisão de literatura serão discutidos em relação à insuficiência cardíaca: seu conceito e um breve histórico; a importância da musculatura esquelética; as anormalidades funcionais, estruturais, bioquímicos e moleculares que acometem esse tecido; as potenciais causas dessas alterações (hiperatividade simpática, redução na ingestão alimentar, espécies reativas de oxigênio, citocinas pró-inflamatórias e diminuição do nível de atividade física e do fluxo sanguíneo); e os efeitos da principal terapia direcionada para combater essa disfunção, o treinamento físico aeróbio de intensidade moderada. Reconhecida a importância do tecido muscular esquelético na síndrome, essa é uma área da investigação científica com muitos temas ainda não estudados, como o efeito de terapias farmacológicas utilizadas pelos pacientes, de exercícios físicos aeróbios de maior intensidade e intervalados, de exercícios físicos de força, de intervenções nutricionais e de terapias celulares e gênicas. No futuro, os resultados desses estudos que serão desenvolvidos certamente contribuirão para uma menor degeneração da musculatura esquelética na doença, o que, consequentemente, vai melhorar a ualidade de vida, a autonomia e o prognóstico dos pacientes.

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Hormonal Changes and Catabolic/Anabolic Imbalance in Chronic Heart Failure and Their Importance for Cardiac Cachexia

Abstract: Cachexia is more closely associated with hormonal changes in CHF than conventional measures of the severity of CHF. This study suggests that the syndrome of heart failure progresses to cardiac cachexia if the normal metabolic balance between catabolism and anabolism is altered.

Cited by 727 publications

References 26 publications

Neurohormonal Activation and the Chronic Heart Failure Syndrome in Adults With Congenital Heart Disease

Neurohormonal Activation and the Chronic Heart Failure Syndrome in Adults With Congenital Heart Disease

Nutrition, Nitrogen Requirements, Exercise and Chemotherapy-Induced Toxicity in Cancer Patients. A puzzle of Contrasting Truths?

Relevância e tratamento das lesões características da insuficiência cardíaca na musculatura esquelética

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