Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany First Department of Internal Medicine, Comenius University, Bratislava, Slovakia
Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany.
Eur Heart J. 2016 Jun 1;37(21):1684-91. doi: 10.1093/eurheartj/ehw008. Epub 2016 Feb 9.
Mechanisms leading to cachexia in heart failure (HF) are not fully understood. We evaluated signs of intestinal congestion in patients with chronic HF and their relationship with cachexia.
Of the 165 prospectively enrolled outpatients with left ventricular ejection fraction ≤40%, 29 (18%) were cachectic. Among echocardiographic parameters, the combination of right ventricular dysfunction and elevated right atrial pressure (RAP) provided the best discrimination between cachectic and non-cachectic patients [area under the curve 0.892, 95% confidence interval (CI): 0.832-0.936]. Cachectic patients, compared with non-cachectic, had higher prevalence of postprandial fullness, appetite loss, and abdominal discomfort. Abdominal ultrasound showed a larger bowel wall thickness (BWT) in the entire colon and terminal ileum in cachectic than in non-cachectic patients. Bowel wall thickness correlated positively with gastrointestinal symptoms, high-sensitivity C-reactive protein, RAP, and truncal fat-free mass, the latter serving as a marker of the fluid content. Logistic regression analysis showed that BWT was associated with cachexia, even after adjusting for cardiac function, inflammation, and stages of HF (odds ratio 1.4, 95% CI: 1.0-1.8; P-value = 0.03). Among the cardiac parameters, only RAP remained significantly associated with cachexia after multivariable adjustment.
Cardiac cachexia was associated with intestinal congestion irrespective of HF stage and cardiac function. Gastrointestinal discomfort, appetite loss, and pro-inflammatory activation provide probable mechanisms, by which intestinal congestion may trigger cardiac cachexia. However, our results are preliminary and larger studies are needed to clarify the intrinsic nature of this relationship.
心力衰竭（HF）导致恶病质的机制尚不完全清楚。我们评估了慢性 HF 患者的肠道充血迹象及其与恶病质的关系。
在 165 名前瞻性入选的左心室射血分数≤40%的门诊患者中，有 29 名（18%）患有恶病质。在超声心动图参数中，右心室功能障碍和升高的右心房压（RAP）的组合为区分恶病质和非恶病质患者提供了最佳的区分[曲线下面积 0.892，95%置信区间（CI）：0.832-0.936]。与非恶病质患者相比，恶病质患者餐后饱腹感、食欲减退和腹部不适的发生率更高。腹部超声显示，在整个结肠和末端回肠中，恶病质患者的肠壁厚度（BWT）较大。BWT 与胃肠道症状、高敏 C 反应蛋白、RAP 和躯干去脂体重呈正相关，后者是液体含量的标志物。Logistic 回归分析显示，即使在调整心脏功能、炎症和 HF 分期后，BWT 仍与恶病质相关（比值比 1.4，95%CI：1.0-1.8；P 值=0.03）。在心脏参数中，只有 RAP 在多变量调整后仍与恶病质显著相关。
无论 HF 分期和心脏功能如何，心脏恶病质都与肠道充血有关。胃肠道不适、食欲减退和促炎激活提供了可能的机制，通过这些机制，肠道充血可能引发心脏恶病质。然而，我们的结果是初步的，需要更大的研究来阐明这种关系的内在本质。
