Феномен втрати маси тіла в пацієнтів із хронічною серцевою недостатністю

Abstract

A characteristic sign of chronic heart failure (CHF) is a high frequency of comorbid conditions, one of which is the phenomenon of weight loss. Cardiac cachexia is a systemic metabolic disorder characterized by an unintentional decrease in body weight due to loss of all body components, namely, skeletal muscle, adipose tissue and bone tissue, and identified as a marker of nutritional status, has prognostic value in patients with CHF, regardless of age, NYHA class, left ventricular ejection fraction, and peak oxygen consumption. The article discusses the prevalence, criteria, prognostic significance of cardiac cachexia, as well as immune, metabolic and neurohormonal pathogenetic mechanisms that lead to anabolic-catabolic imbalance and contribute to the progression of CHF. Given the methodological difficulties of proper assessment of unintentional body weight loss over a certain previous period of outpatient follow-up in patients with CHF, it becomes urgent to determine the objective («static») characteristics of the nutritional status of patients, which are associated with an unfavorable clinical prognosis. The article demonstrates the results of our own research to determine prognostic factors based on indicators of the nutritional status of patients the clinical significance of the loss of individual body components is highlighted, preventive and therapeutic approaches to influence body weight loss in patients with CHF are described – nutritional support, neurohormonal blockade, the effect on the intestinal microflora, correction of anemia and iron deficiency, the use of appetite stimulants, immunomodulatory agents, anabolic hormones and physical training.