Cachexia and right ventricular dysfunction in chronic heart failure: what is the chicken and what the egg?

Abstract

This editorial refers to ‘Intestinal congestion and right ventricular dysfunction: a link with appetite loss, inflammation, and cachexia in chronic heart failure’[†][1], by M. Valentova et al ., on page 1684. Heart failure (HF) is a major health problem with significant personal, societal, and economic implications, and can be defined as abnormalities in cardiac structure and function resulting in the inability of the heart to deliver oxygen and nutrients via the blood stream to the metabolizing tissues at an appropriate rate. Typical syndromes in HF patients are breathlessness, ankle swelling, and fatigue. Further, elevated jugular venous pressure and pulmonary crackles are prevalent in HF. In developed countries, >10% of individuals aged 70 years or older are diagnosed with HF.1 Despite significant improvements in therapy, patients suffering from HF still have a poor diagnosis. A total of 17–45% of patients hospitalized due to HF die within 1 year of admission.2 Even though historically HF was only associated with left ventricular function, it is now recognized that the right side of the heart is also affected. Furthermore, HF has significant systemic effects, which influence the outcome of patients. For example, fluids may be retained in the lungs, kidneys, and liver, thereby reducing the patient's ability to exercise, and to excrete salt and water as well as toxins from the body. In addition, the intestines become … [1]: #fn-2