(Circulation. 1997;96:526-534.)
© 1997 American Heart Association, Inc.
Articles |
Hormonal Changes and Catabolic/Anabolic Imbalance in Chronic Heart Failure and Their Importance for Cardiac Cachexia
From Cardiac Medicine, National Heart and Lung Institute, Imperial College School of Medicine, London, UK (S.D.A., T.P.C., P.P., D.H., J.W.S., P.A.P.-W., A.J.S.C.); the Department of Internal Medicine III/Cardiology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany (S.D.A.); and the Department of Anesthesiology and Intensive Care Medicine, University Hospital Charité, Humboldt University Berlin, Germany (W.J.K.).
Background The role of hormonal and cytokine abnormalities in the development of cardiac cachexia remains obscure.
Methods and Results Healthy control subjects (n=16) and
patients with chronic heart failure (CHF), classified clinically as
cachectic (8% to 35% weight loss over 
6 months before study, n=16)
or noncachectic (n=37), were assessed for markers of disease severity
(maximal oxygen consumption, left ventricular ejection
fraction, NYHA functional class). These markers were compared with
plasma concentrations of potentially important anabolic and catabolic
factors. The degree of neurohormonal activation and catabolic/anabolic
imbalance was closely related to wasting but not to conventional
measures of the severity of heart failure. Compared with control
subjects and noncachectic patients, cachectic patients had reduced
plasma sodium and increased norepinephrine,
epinephrine (all P<.0001), cortisol, tumor necrosis
factor (TNF)-
(both P<.002), and human growth hormone
(P<.05). Insulin-like growth factor-1, testosterone, and
estrogen were similar in all groups. Insulin was increased only in the
noncachectic patients (P<.005 versus control subjects).
Dehydroepiandrosterone was reduced in the cachectic patients
(P<.02 versus control subjects). Insulin, cortisol,
TNF-, and norepinephrine correlated independently with
wasting in CHF (P<.05; multiple regression of these four
factors versus percent ideal weight, R2=.50,
P<.0001).
Conclusions Cachexia is more closely associated with hormonal changes in CHF than conventional measures of the severity of CHF. This study suggests that the syndrome of heart failure progresses to cardiac cachexia if the normal metabolic balance between catabolism and anabolism is altered.
Key Words: heart failure • hormones • metabolism • catecholamines • cachexia
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P. C. Schulze, J. Kratzsch, A. Linke, N. Schoene, V. Adams, S. Gielen, S. Erbs, S. Moebius-Winkler, and G. Schuler Elevated serum levels of leptin and soluble leptin receptor in patients with advanced chronic heart failure Eur J Heart Fail, January 1, 2003; 5(1): 33 - 40. [Abstract] [Full Text] [PDF]
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P. J. Pugh, R. D. Jones, T.H. Jones, and K. S. Channer Heart failure as an inflammatory condition: potential role for androgens as immune modulators Eur J Heart Fail, December 1, 2002; 4(6): 673 - 680. [Abstract] [Full Text] [PDF]
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P.R. Kalra, P.P. Ponikowski, and S.D. Anker Sympathetic activation and malignant ventricular arrhythmias: a molecular link? Eur. Heart J., July 2, 2002; 23(14): 1078 - 1080. [Full Text] [PDF]
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A. P. Bolger, R. Sharma, W. Li, M. Leenarts, P. R. Kalra, M. Kemp, A. J.S. Coats, S. D. Anker, and M. A. Gatzoulis Neurohormonal Activation and the Chronic Heart Failure Syndrome in Adults With Congenital Heart Disease Circulation, July 2, 2002; 106(1): 92 - 99. [Abstract] [Full Text] [PDF]
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R. Hambrecht, P. C. Schulze, S. Gielen, A. Linke, S. Mobius-Winkler, J. Yu, J.u. Kratzsch, G. Baldauf, M. W. Busse, A. Schubert, et al. Reduction of insulin-like growth factor-I expression in the skeletal muscle of noncachectic patients with chronic heart failure J. Am. Coll. Cardiol., April 3, 2002; 39(7): 1175 - 1181. [Abstract] [Full Text] [PDF]
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R Sharma and S.D Anker From tissue wasting to cachexia: changes in peripheral blood flow and skeletal musculature Eur. Heart J. Suppl., April 1, 2002; 4(suppl_D): D12 - D17. [Abstract] [PDF]
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M. Imazio, M. Bobbio, F. Broglio, A. Benso, V. Podio, M.R. Valetto, G. Bisi, E. Ghigo, and G.P. Trevi GH-independent cardiotropic activities of hexarelin in patients with severe left ventricular dysfunction due to dilated and ischemic cardiomyopathy Eur J Heart Fail, March 1, 2002; 4(2): 185 - 191. [Abstract] [Full Text] [PDF]
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A. Nohria, E. Lewis, and L. W. Stevenson Medical Management of Advanced Heart Failure JAMA, February 6, 2002; 287(5): 628 - 640. [Abstract] [Full Text] [PDF]
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K. T. Weber Aldosterone in Congestive Heart Failure N. Engl. J. Med., December 6, 2001; 345(23): 1689 - 1697. [Full Text] [PDF]
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A.L. Clark, M. Loebe, E.V. Potapov, K. Egerer, C. Knosalla, R. Hetzer, and S.D. Anker Ventricular assist device in severe heart failure. Effects on cytokines, complement and body weight Eur. Heart J., December 2, 2001; 22(24): 2275 - 2283. [Abstract] [PDF]
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C.-W. Kong, T.-G. Hsu, F.-J. Lu, W.-L. Chan, and K. Tsai Leukocyte mitochondria depolarization and apoptosis in advanced heart failure: clinical correlations and effect of therapy J. Am. Coll. Cardiol., November 15, 2001; 38(6): 1693 - 1700. [Abstract] [Full Text] [PDF]
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A. J S Coats HEART FAILURE: What causes the symptoms of heart failure? Heart, November 1, 2001; 86(5): 574 - 578. [Full Text] [PDF]
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N. Nagaya, M. Uematsu, M. Kojima, Y. Date, M. Nakazato, H. Okumura, H. Hosoda, W. Shimizu, M. Yamagishi, H. Oya, et al. Elevated Circulating Level of Ghrelin in Cachexia Associated With Chronic Heart Failure: Relationships Between Ghrelin and Anabolic/Catabolic Factors Circulation, October 23, 2001; 104(17): 2034 - 2038. [Abstract] [Full Text] [PDF]
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N. Nagaya, M. Uematsu, M. Kojima, Y. Ikeda, F. Yoshihara, W. Shimizu, H. Hosoda, Y. Hirota, H. Ishida, H. Mori, et al. Chronic Administration of Ghrelin Improves Left Ventricular Dysfunction and Attenuates Development of Cardiac Cachexia in Rats With Heart Failure Circulation, September 18, 2001; 104(12): 1430 - 1435. [Abstract] [Full Text] [PDF]
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Task Force for the Diagnosis and Treatment of Chro, W. J. Remme, and K. Swedberg Guidelines for the diagnosis and treatment of chronic heart failure Eur. Heart J., September 1, 2001; 22(17): 1527 - 1560. [PDF]
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S. HEINDL, M. LEHNERT, C.-P. CRIEE, G. HASENFUSS, and S. ANDREAS Marked Sympathetic Activation in Patients with Chronic Respiratory Failure Am. J. Respir. Crit. Care Med., August 15, 2001; 164(4): 597 - 601. [Abstract] [Full Text] [PDF]
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P. R Kalra, S. D Anker, and A. J.S Coats Water and sodium regulation in chronic heart failure: the role of natriuretic peptides and vasopressin Cardiovasc Res, August 15, 2001; 51(3): 495 - 509. [Full Text] [PDF]
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S. D. Anker, M. Volterrani, C.-D. Pflaum, C. J. Strasburger, K. J. Osterziel, W. Doehner, M. B. Ranke, P. A. Poole-Wilson, A. Giustina, R. Dietz, et al. Acquired growth hormone resistance in patients with chronic heart failure: implications for therapy with growth hormone J. Am. Coll. Cardiol., August 1, 2001; 38(2): 443 - 452. [Abstract] [Full Text] [PDF]
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A. Jacobsson, E. Pihl-Lindgren, and B. Fridlund Malnutrition in patients suffering from chronic heart failure; the nurse's care Eur J Heart Fail, August 1, 2001; 3(4): 449 - 456. [Abstract] [Full Text] [PDF]
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G. Akner and T. Cederholm Treatment of protein-energy malnutrition in chronic nonmalignant disorders Am. J. Clinical Nutrition, July 1, 2001; 74(1): 6 - 24. [Abstract] [Full Text] [PDF]
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K. K. A. Witte, A. L. Clark, and J. G. F. Cleland Chronic heart failure and micronutrients J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1765 - 1774. [Abstract] [Full Text] [PDF]
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A.Q. Adigun and A.A. L. Ajayi The effects of enalapril-digoxin-diuretic combination therapy on nutritional and anthropometric indices in chronic congestive heart failure: preliminary findings in cardiac cachexia Eur J Heart Fail, June 1, 2001; 3(3): 359 - 363. [Abstract] [Full Text] [PDF]
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