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Clinical and prognostic relevance of cardiac wasting in patients with advanced cancer

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Item Type:Article
Title:Clinical and prognostic relevance of cardiac wasting in patients with advanced cancer
Creators Name:Lena, A. and Wilkenshoff, U. and Hadzibegovic, S. and Porthun, J. and Rösnick, L. and Fröhlich, A.K. and Zeller, T. and Karakas, M. and Keller, U. and Ahn, J. and Bullinger, L. and Riess, H. and Rosen, S.D. and Lyon, A.R. and Lüscher, T.F. and Totzeck, M. and Rassaf, T. and Burkhoff, D. and Mehra, M.R. and Bax, J.J. and Butler, J. and Edelmann, F. and Haverkamp, W. and Anker, S.D. and Packer, M. and Coats, A.J.S. and von Haehling, S. and Landmesser, U. and Anker, M.S.
Abstract:BACKGROUND: Body wasting in patients with cancer can affect the heart. OBJECTIVES: The frequency, extent, and clinical and prognostic importance of cardiac wasting in cancer patients is unknown. METHODS: This study prospectively enrolled 300 patients with mostly advanced, active cancer but without significant cardiovascular disease or infection. These patients were compared with 60 healthy control subjects and 60 patients with chronic heart failure (ejection fraction <40%) of similar age and sex distribution. RESULTS: Cancer patients presented with lower left ventricular (LV) mass than healthy control subjects or heart failure patients (assessed by transthoracic echocardiography: 177 ± 47 g vs 203 ± 64 g vs 300 ± 71 g, respectively; P < 0.001). LV mass was lowest in cancer patients with cachexia (153 ± 42 g; P < 0.001). Importantly, the presence of low LV mass was independent of previous cardiotoxic anticancer therapy. In 90 cancer patients with a second echocardiogram after 122 ± 71 days, LV mass had declined by 9.3% ± 1.4% (P < 0.001). In cancer patients with cardiac wasting during follow-up, stroke volume decreased (P < 0.001) and resting heart rate increased over time (P = 0.001). During follow-up of on average 16 months, 149 patients died (1-year all-cause mortality 43%; 95% CI: 37%-49%). LV mass and LV mass adjusted for height squared were independent prognostic markers (both P < 0.05). Adjustment of LV mass for body surface area masked the observed survival impact. LV mass below the prognostically relevant cutpoints in cancer was associated with reduced overall functional status and lower physical performance. CONCLUSIONS: Low LV mass is associated with poor functional status and increased all-cause mortality in cancer. These findings provide clinical evidence of cardiac wasting–associated cardiomyopathy in cancer.
Keywords:Cancer, Cardiac Wasting-Associated Cardiomyopathy, Cardiology, Echocardiography, Left Ventricular Mass
Source:Journal of the American College of Cardiology
Page Range:1569-1586
Date:25 April 2023
Official Publication:https://doi.org/10.1016/j.jacc.2023.02.039
PubMed:View item in PubMed

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