Relation of respiratory muscle strength, cachexia and survival in severe chronic heart failure

Abstract

BackgroundRespiratory muscle (RM) function predicts prognosis in non-cachectic patients with chronic heart failure (CHF). We hypothesized that weakness of RM (maximum inspiratory mouth occlusion pressure, Pimax) is a function of body mass index, and that outcome is more a function of BMI than of Pimax or ventilatory drive (P0.1).Subjects and methodsWe enrolled 249 CHF patients (11.2 % female, median age 54.2 years) at the German Heart Institute Berlin. Patients were in NYHA classes I/II/III/IV by n = 16/90/108/35. All patients underwent tests of pulmonary function, RM (Pimax, P0.1), cardiopulmonary exercise testing (peakVO2, VE/VCO2-slope), and right heart catheterization.ResultsMean follow-up time was 18 (1–36) months, 47 patients (18.9 %) died or underwent cardiac assist implantation. Pimax correlated weakly with BMI (r = 0.19), peakVO2 (r = 0.15), and FEV1 (r = 0.34, all p < 0.02), and was lower in females compared to males (3.9 ± 1.7 vs. 6.6 ± 2.7 kPa; p < 0.001). P0.1 correlated with pulmonary pressure (rho = 0.2; p < 0.01) and peakVO2 (rho = −0.14; p < 0.02). Neither Pimax [hazard ratio (HR) 0.98; confidence interval (CI) 0.88–1.08] nor P0.1 (HR 0.52; 0.06–4.6) predicted survival. Multivariate regression analysis revealed gender, BMI, and FEV1 as cofactors of Pimax, with only BMI (HR 0.87; CI 0.80–0.95) predicting survival independently. The lowest quintile in BMI had the worst outcome (log-rank χ² = 13.5, p = 0.009).SummaryIn CHF patients including cachexia and NYHA IV, Pimax does not predict survival. Pimax depends on gender, BMI, FEV1, and peakVO2, with only BMI and peakVO2 predicting survival. The impaired Pimax in CHF might be a result of catabolism and weight loss and is not a predictive factor in itself.

Oxidative and proteolytic profiles of the right and left heart in a model of cancer-induced cardiac cachexia

“…The loss of cardiac mass in chronic diseases such as cancer, heart failure, and obstructive pulmonary disease has been extensively reported [29][30][31][32][33][34], but the mechanisms responsible for this process are only partially elucidated [35]. In rats implanted with Walker-256 tumours -a carcinosarcoma of the mammary glands of pregnant rats [36] -tumour growth occurred quickly, causing progressive weight loss and leading to cachexia syndrome within only5 days.…”

Clinical perspective for wasting in diaphragm, an ever‐trained muscle

“…Besides, malnutrition may disrupt the effect of exercise training,4 and anabolic hormone may be insufficient in some patients 5. In a recent clinical research,6 the prognostic impact of respiratory muscle wasting was not consistent with the results from studies in 1990s,7, 8 suggesting heterogeneity in the significance of respiratory muscle wasting in HF patients, which may not have been observed in animals. In limb muscle on the other hand, deconditioning may prevalently exist under wasting and attenuate the heterogeneity in the prognostic significance of wasting.…”

Cachexia: clinical features when inflammation drives malnutrition

“…Cachexia is clinically relevant since it impacts on patients' quality of life, morbidity and mortality (25)(26)(27) . Nevertheless, the assessment of patients' nutritional status does not represent a priority in many clinical settings (28) .…”

“…Cachexia is associated with worse outcome (25)(26)(27) . In order to develop effective therapies, it should be first assessed whether anabolic potential is still exploitable in patients with acute and chronic diseases.…”