Journal Article

DKFZ-2023-00774

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Clinical and Prognostic Relevance of Cardiac Wasting in Patients With Advanced Cancer

Lena, A. ; Wilkenshoff, U. ; Hadzibegovic, S. ; Porthun, J. ; Rösnick, L. ; Fröhlich, A.-K. ; Zeller, T. ; Karakas, M. ; Keller, U.DKFZ* ; Ahn, J. ; Bullinger, L.DKFZ* ; Riess, H. ; Rosen, S. D. ; Lyon, A. R. ; Lüscher, T. F. ; Totzeck, M. ; Rassaf, T. ; Burkhoff, D. ; Mehra, M. R. ; Bax, J. J. ; Butler, J. ; Edelmann, F. ; Haverkamp, W. ; Anker, S. D. ; Packer, M. ; Coats, A. J. S. ; von Haehling, S. ; Landmesser, U. ; Anker, M. S.

2023
American College of Cardiology New York, NY

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Please use a persistent id in citations: doi:10.1016/j.jacc.2023.02.039

Abstract: Background:Body wasting in patients with cancer can affect the heart.Objectives:The frequency, extent, and clinical and prognostic importance of cardiac wasting in cancer patients is unknown.Methods: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.Results: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.Conclusions: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.

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Contributing Institute(s):

1. DKTK BE zentral (BE01)

Research Program(s):

1. 899 - ohne Topic (POF4-899) (POF4-899)

Appears in the scientific report 2023

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Database coverage:
; BIOSIS Previews ; Biological Abstracts ; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; Current Contents - Life Sciences ; Ebsco Academic Search ; Essential Science Indicators ; IF >= 20 ; JCR ; SCOPUS ; Science Citation Index Expanded ; Web of Science Core Collection

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