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Cardiac Wasting in Patients With Advanced Cancer
Quick Takes
- Patients with advanced-stage cancer have reduced LV mass in comparison with patients without CVD or patients with chronic systolic heart failure (LVEF <40%).
- LV mass was reduced in advanced-stage cancer patients and was associated with increased all-cause mortality, whether anticancer therapy-naïve or if previously received cardiotoxic or noncardiotoxic therapy.
- Cancer patients showed significantly lower LV mass compared to the healthy control group after adjustment for square of height rather than body surface area.
Study Questions:
Do patients with advanced-stage cancer have a reduction in cardiac mass that affects functional status and prognosis?
Methods:
This prospective study enrolled hospitalized advanced-stage cancer patients (n = 300) with left ventricular ejection fraction (LVEF) >50% and no history of significant cardiovascular disease (CVD). Two control groups of similar sex and age were used as comparison: a healthy control group (n = 60) without significant CVD and a chronic heart failure (HF) control group (n = 60) with LVEF <40%. All patients underwent biomarker, 12-lead electrocardiography, and body surface area analyses. Cachexia, defined as involuntary weight loss associated with skeletal muscle mass and fat tissue, which occurs in 30-80% of cancer patients, was studied using functional assessments of maximum handgrip strength, 4-meter gait speed, 10-step stair-climbing power test, and 6-minute walk test. A 2-D echocardiogram was performed within 12 months of enrollment and at follow-up (mean 122 ± 71 days).
Results:
Cancer patients showed significantly lower LV mass, especially in the lower LV internal diameter and posterior wall thickness at end-diastole. LV mass in the cancer group was similarly reduced in anticancer therapy-naïve patients and in patients who either previously received cardiotoxic or noncardiotoxic therapy. Cachectic cancer patients had a significant reduction in LVEF, cardiac output, stroke volume, global longitudinal strain, and increased heart rate.
At follow-up, 50% of cancer patients (n = 149) had died (1-year survival, 57%; 95% confidence interval, 51-63%). The absolute LV mass to predict overall survival in females was <151 g and <210 g in males (relative risk increase 72%, p = 0.001). At follow-up, the cancer group had a significant reduction in LV mass from baseline (9.3% ± 1.4%) with significant LV mass loss >10%. Inflammatory marker interleukin-6 was significantly increased in cancer patients. The overall functional assessments were significantly reduced in patients with reduced LV mass.
Conclusions:
This study found that advanced-stage cancer patients, whether anticancer therapy-naïve or having received cardiotoxic or cardiotoxic anticancer therapy, present with lower absolute LV mass adjusted for height squared in comparison with healthy control or chronic systolic HF patients. In addition, LV mass loss was associated with poor functional status and increased all-cause mortality.
Perspective:
The findings of this study suggest that progressive cachexia and poor functional status, known to occur in later stages of cancer, is associated with cardiac wasting and is prognostic for all-cause mortality. Current therapies being investigated support these findings by using beta-blockers and aldosterone receptor antagonists to minimize cancer-related cachexia or cardiac wasting-associated cardiomyopathy.
Clinical Topics: Cardio-Oncology, Heart Failure and Cardiomyopathies, Noninvasive Imaging, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Echocardiography/Ultrasound
Keywords: Biomarkers, Body Surface Area, Cachexia, Cardiomyopathies, Cardiotoxicity, Diagnostic Imaging, Diastole, Echocardiography, Electrocardiography, Heart Failure, Interleukins, Neoplasms, Patient Care Team, Risk, Stroke Volume, Ventricular Function, Left
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