Abstract
Background: Cachexia is an unfavorable metabolic syndrome causing involuntary weight loss followed by muscle wasting, which can lead to the exacerbation of chronic heart failure (CHF), and considerably increases mortality rate among CHF patients. Unfortunately, until now it has not been possible to determine factors that could improve clinical options for cachexia management or enable the identification of patients at risk of its development. We assessed how cachexia conditions in CHF reflect cardiac and laboratory parameters in comparison with non-cachectic patients. Methods: 66 women were enrolled to the study group and underwent meticulous screening, according to recent clinical guidelines, in order to enable CHF and cachexia detection. Body composition was evaluated by bioelectrical impedance analysis (BIA) and laboratory tests were supplemented by analysis of plasma circulating irisin. Results: A negative correlation between irisin concentration and both CRP and TNF-α was recorded (R = −0.362 and R = −0.243; p < 0.05). Irisin concentration positively correlated with EF% (R = 0.253; p = 0.046) and negatively with LVESd, LVEDd and NT-proBNP (R = −0.326, −0.272, and −0.320; p < 0.05). Both low levels of circulating irisin and Capacitance of membrane (Cm) were selected as unfavorable factors affecting cachexia in CHF patients (OR = 1.39 and 34.49; p < 0.05). Combination of Cm, irisin, CRP and albumin demonstrated sensitivity of 93.3% and specificity of 85.3% (AUC = 0.949) for distinguishing between cachectic and non-cachectic CHF patients. Conclusions: Selected parameters reliably reflect cachectic conditions in CHF, and the proposed approach for cachexia based on the combined analysis of at least a few non-invasive markers could offer new opportunities for improving clinical outcomes in CHF patients.
Highlights
Chronic heart failure (CHF) is a disease with growing incidence in adults in highly developed countries, and itsrisk factors include presence of other cardiovascular diseases or the coexistence of chronic diseases [1,2]
Due to metabolic alterations associated with the disease, chronic heart failure (CHF) patients are increasingly diagnosed with heart failure-induced cachexia, which is diagnosed in 8–42% CHF patients, and the mortality rate is roughly 20–30%
All of the following parameters reflecting the nutritional status of CHF patients—body weight, BMI, fat mass (FM), fat-free mass (FFM) and albumin—were significantly reduced in the cachexia group (p < 0.05)
Summary
Chronic heart failure (CHF) is a disease with growing incidence in adults in highly developed countries, and itsrisk factors include presence of other cardiovascular diseases or the coexistence of chronic diseases [1,2]. The two potentially clinically useful parameters, which can be obtained from BIA, are membrane capacitance (Cm) and phase angle (PA) They show clinical usefulness in the body composition assessment and the detection of malnutrition and demonstrate a prognostic value in various diseases accompanied by malnutrition, including CHF [1,10,11,12]. Irisin concentration positively correlated with EF% (R = 0.253; p = 0.046) and negatively with LVESd, LVEDd and NT-proBNP (R = −0.326, −0.272, and −0.320; p < 0.05) Both low levels of circulating irisin and Capacitance of membrane (Cm) were selected as unfavorable factors affecting cachexia in CHF patients (OR = 1.39 and 34.49; p < 0.05). Conclusions: Selected parameters reliably reflect cachectic conditions in CHF, and the proposed approach for cachexia based on the combined analysis of at least a few non-invasive markers could offer new opportunities for improving clinical outcomes in CHF patients
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