Lena Alessia, Wilkenshoff Ursula, Hadzibegovic Sara, Porthun Jan, Rösnick Lukas, Fröhlich Ann-Kathrin, Zeller Tanja, Karakas Mahir, Keller Ulrich, Ahn Johann, Bullinger Lars, Riess Hanno, Rosen Stuart D, Lyon Alexander R, Lüscher Thomas F, Totzeck Matthias, Rassaf Tienush, Burkhoff Daniel, Mehra Mandeep R, Bax Jeroen J, Butler Javed, Edelmann Frank, Haverkamp Wilhelm, Anker Stefan D, Packer Milton, Coats Andrew J S, von Haehling Stephan, Landmesser Ulf, Anker Markus S
Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Berlin, Germany; Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; German Centre for Cardiovascular Research, partner site Berlin, Berlin, Germany; Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany.
Department of Cardiology, Angiology and Intensive Care Medicine Campus Benjamin Franklin, German Heart Center Charité, Berlin, Germany; Charité - University Medicine Berlin, corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany; Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany.
J Am Coll Cardiol. 2023 Apr 25;81(16):1569-1586. doi: 10.1016/j.jacc.2023.02.039.
Body wasting in patients with cancer can affect the heart.
The frequency, extent, and clinical and prognostic importance of cardiac wasting in cancer patients is unknown.
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.
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.
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.
癌症患者的身体消瘦会影响心脏。
癌症患者心脏消瘦的频率、程度以及临床和预后重要性尚不清楚。
本研究前瞻性纳入了300例大多为晚期、活动性癌症但无明显心血管疾病或感染的患者。将这些患者与60名健康对照者以及60名年龄和性别分布相似的慢性心力衰竭（射血分数<40%）患者进行比较。
癌症患者的左心室（LV）质量低于健康对照者或心力衰竭患者（经胸超声心动图评估：分别为177±47g、203±64g和300±71g；P<0.001）。恶病质癌症患者的LV质量最低（153±42g；P<0.001）。重要的是，LV质量低的存在与既往心脏毒性抗癌治疗无关。在90例癌症患者122±71天后进行第二次超声心动图检查时，LV质量下降了9.3%±1.4%（P<0.001）。在随访期间出现心脏消瘦的癌症患者中，每搏输出量减少（P<0.001），静息心率随时间增加（P=0.001）。在平均16个月的随访期间，149例患者死亡（1年全因死亡率43%；95%CI：37%-49%）。LV质量和根据身高平方调整后的LV质量是独立的预后标志物（均P<0.05）。根据体表面积调整LV质量掩盖了观察到的生存影响。癌症患者中低于预后相关切点的LV质量与整体功能状态降低和身体表现较差有关。
LV质量低与癌症患者的功能状态差和全因死亡率增加有关。这些发现为癌症中与心脏消瘦相关的心肌病提供了临床证据。
