Copyright © 1999 by the European Society of Cardiology.
Cytokines and neurohormones relating to body composition alterations in the wasting syndrome of chronic heart failure
a Department of Cardiac Medicine, National Heart and Lung Institute, London, U.K.
b Franz-Volhard-Klinik at Max Delbrück Centrum for Molecular Medicine, Charité, Campus Berlin-Buch, Berlin, Germany
c Department of Biochemistry, Royal Brompton Hospital, London, U.K.
d Department of Applied Pharmacology, National Heart and Lung Institute, London, U.K.
revised December 8, 1998; accepted December 9, 1998
Abstract
Background
Chronic heart failure is one of a number of disorders associated with the development of a wasting syndrome. The precise mechanisms of this remain unknown, but previous studies have suggested a role for immune and neurohormonal factors.
Methods
We aimed to investigate in detail the differences in body composition (dual X-ray absorptiometry) and the relationship to candidate biochemical factors of the immune, neurohormonal and metabolic systems in 15 healthy controls, 36 stable non-cachectic and 18 cachectic patients with chronic heart failure.
Results
Non-cachectic patients showed reduced leg lean tissue (–9·1%,P<0·01) compared to controls. Cachectic patients had significantly reduced lean (–21·0% vs controls, –19·9% vs non-cachectics), fat (–33·0% vs controls, –37·0% vs non-cachectics) and bone tissue (–17·5% vs controls, –15·9% vs non-cachectics) (allP<0·0001). Cachectic patients showed a significantly increased cortisol/dehydroepiandrosterone ratio (+203% vs controls,P<0·0001; +89% vs non-cachectics,P=0·0011) and increased cytokine levels (TNF-
, soluble TNF-receptor 1, interleukin-6). The levels of catabolic hormones and cytokines correlated significantly with reduced muscle and fat tissue content and reduced bone mass.
Conclusion
Peripheral loss of muscle tissue is a general finding in chronic heart failure. The wasting in cardiac cachexia affects all tissue compartments and is significantly related to neurohormonal and immunological abnormalities.
Key Words: Heart failure, cytokines, body composition, cachexia.
f1 Correspondence: Dr Stefan Anker, Department of Cardiac Medicine, National Heart and Lung Institute London, Dovehouse Street, London SW3 6LY, U.K.
f2 Dr Stefan Anker is supported by a Postgraduate Fellowship of the Max Delbrück Centrum, Berlin, Germany.
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