Influence of Transiently Increased Nutritional Risk on a Left Ventricle Myocardial Mass Assessed by Echocardiography

Abstract

Background/Aim: Metabolic derangements due to increased nutritional risk lead to catabolism and loss of proteins, muscle tissue and eventually mass of parenchymatous organs. The aim of our study was to assess whether transitory nutritional risk after heart surgery influences on the left ventricle myocardial mass (LVMM), assessed by echocardiography. Methods: Consecutive sample of patients scheduled for cardiovascular rehabilitation, in period 0-3 months after surgery. Nutritional risk screening (NRS) was analyzed using the NRS-2002 tool. Results: Study sample included 330 patients after heart surgery for ischemic 186 (56.4%); valvular 91 (27.6%) and valvular plus ischemic 53 (16.1%) heart disease. Age was 65.5 ± 10.6 (range 23-84) and there were more male patients than female - 240 (72.7%) and 90 (27.3%), respectively. The percentage of unintentional loss of weight was 10.8 ± 3.4%, in range 0-23.81%, whereas NRS-2002 was 4.4 ± 1.1. LVMM was 218.7 ± 65.9 g vs. 252.3 ± 51.7 (p = 0.015); for patients with increased nutritional risk and controls, respectively. There was no significant correlation of LVMM with NRS-2002, while the percentage of unintentional loss of weight displayed only weakly inverse correlation (Rho CC = -0.197; p = 0.007). LVMM also correlated significantly with body mass index (Rho CC = 0.247; p < 0.001) and waist-to-hip ratio (Rho CC = 0.291; p < 0.001). In conclusion, LVMM was found to decrease slightly in the period of increased nutritional risk, following heart surgery. Changes in LVMM are partially consequences of systemic catabolic response, as well as anthropometric changes due to unintentional loss of weight.

Current Evidence about Nutrition Support in Cardiac Surgery Patients—What Do We Know?

“…Some cardiac surgery patients experience a complicated postoperative course, requiring pharmacological and/or mechanical cardiac support, as well as prolonged mechanical ventilation. These patients are frequently hypercatabolic, unable to feed themselves for more than 5–6 days and are in special need of intense nutrition support [ 72 , 73 ]. Besides, it was demonstrated that weight-loss in patients discharged after cardiac surgery was accompanied by a persistent inflammatory response resulting in decreased physical functioning [ 74 ].…”

Nutritional Considerations of Cardiovascular Diseases and Treatments

“…127 Even the decrease of cardiac muscle tissue could be found on conventional transthoracic echocardiography. 131 It is noteworthy to mention that this inconspicuous muscle loss happens while the overall loss of weight still did not develop, and it precedes clinically overt cachexia and that it is prognostically relevant for patients. 132 Therapeutic interventions for cardiac cachexia in HF include physical training and pharmaceuticals like testosterone, growth hormone, ghrelin, supplementation of iron, and enteral substitution of essential nutrients.…”