Cardiac cachexia: hic et nunc: “hic et nunc” — here and now☆
Section snippets
Epidemiological aspects of cardiac cachexia
Through prevalence of chronic disease, lack of specific therapies or non-implementation of existing and evidence based management, cachexia evolved to a public health issue [1]. Most of epidemiological figures are based on different cachexia definitions and derived from heterogeneous populations [2]. One would hope this would change with a consensus cachexia definition published in 2008 [3]. However, literature speaks for itself as we are still in need of quality and quantity on this topic [4].
Advances in patophysiology of cardiac cachexia
The pathophysiology of cardiac cachexia (CC) is complex and multifactorial including several factors interacting in a complex system with immune, metabolic, and neurohormonal consequences, which induce catabolic and anabolic imbalance [3]. The overall net catabolic dominance in HF provokes systemic tissue wasting [11]. Skeletal muscle loss may be the most clinically relevant aspect, as it determines physical capacity and symptomatic severity of HF. However, bone and fat compartment are also
Emerging biomarkers of CC
Despite the high morbidity and mortality associated to CC, there is no universally accepted specific biomarkers for this condition, which makes its diagnosis and treatment difficult [60], [61], [62]. Currently, wasting assessment is limited only to quantification of muscle mass based on imaging and functional tests to quantify muscle function. However, all are expensive and only available at medical centers equipped to do so. In addition, such tests only allow for wasting detection, but not for
Therapeutic strategies for CC
The development of preventive and therapeutic strategies against cachexia, sarcopenia and wasting disorders is perceived as an urgent need by healthcare professionals [99], [100]. However, the treatment of skeletal muscle wasting remains an unresolved challenge to this day. As CC is a multifactorial disorder, it is unlikely that any single agent will be completely effective in treating this condition, thus it will be necessary to target different pathways. Fig. 1 summarizes some potential
Gaps in evidence based management of body wasting and cachexia
To improve design of interventional trials, we need to gain better insight into epidemiology, trajectories, and pathways of body wasting in chronic disease. It is not irrelevant, how and why the patients die [164]. Knowing the most common causes and also modes of death can lead to application of well established therapies, e.g. beta-blockers or devices for sudden cardiac death. Body wasting and cachexia are usually recognized when patients experience certain limitations in activities of daily
Conclusion
CC is the clinical entity at the end of chronic natural course of HF. A simplistic view could be that with effective prevention, incidence of CC would be low or non-existing. In real world, multiple factors influence disease trajectories in this syndrome. Detection of the pathways that modulate muscle wasting and dysfunction will provide important information for the definition of CC-specific biomarkers and for the development of medications that counteract muscle impairment, which will
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This paper is also published in J Cachexia Sarcopenia Muscle.