382. CARDIAC REMODELING IN PATIENTS WITH ESOPHAGEAL CANCER-ASSOCIATED CACHEXIA

Abstract

Abstract Background Cachexia is a debilitating wasting syndrome affecting 60% of patients with esophageal cancer, regardless of stage. While cachexia is usually characterized by skeletal muscle atrophy, systemic inflammation and aberrant endocrine signaling is thought to also precipitate cardiac atrophy and dysfunction. Indeed, cachectic patients often display clinical signs of heart failure. In this initial study, we sought to characterize the relationships between weight loss, body composition and parameters of cardiac structure and function. Methods We performed a retrospective review of patients that received esophagectomy between 2015 and 2020 at our facility. Male patients with pre-operative transthoracic echocardiogram studies and no prior history of cardiac disease were included. Body composition was measured using PET/CT scans. Patients were classified as having cachexia if having more than 8% loss in body mass in the six months before surgery. Appropriate t-tests and correlational analyses were performed after assessing normality. A p-value less than 0.05 was considered statistically significant. Results Mean age was 65.8 ± 7.54 years. Mean six-month weight loss was 13.2%, and 65.4% of patients were classified as having cachexia. Patients with cachexia tended to have lower left ventricular mass (135 ± 7.38 g v. 148 ± 7.53 g, p = 0.2) and significantly lower left atrial diameter (3.32 ± 0.441 cm v. 4.47 ± 0.515 cm, p = 0.0261). Curiously, pre-operative weight loss positively correlated with left ventricular internal diameter end systole (R = 0.4521, p = 0.0204) and negatively correlated with diastolic blood pressure (R = -0.4102, p = 0.0417). When compared to segmented PET/CT scans, patients with increased deposition of adipose to muscle—a sign of pathologic remodeling—also had decreased left atrial diameter (R = 0.6497, p = 0.0222). Conclusions Various measures of heart structure and function are altered in cachectic patients with esophageal cancer. Patients were more weight loss have reduced left atrial and increased left ventricular diameters. These findings suggest that cardiac structure may dynamically change in response to cachexia. In summary, there is a profound need to better characterize the pathology of cardiac atrophy and dysfunction in patients with cachexia.