Background

Chronic heart failure is one of a number of disorders associated with the development of a wasting syndrome. The precise mechanisms of this remain unknown, but previous studies have suggested a role for immune and neurohormonal factors.

Methods

We aimed to investigate in detail the differences in body composition (dual X-ray absorptiometry) and the relationship to candidate biochemical factors of the immune, neurohormonal and metabolic systems in 15 healthy controls, 36 stable non-cachectic and 18 cachectic patients with chronic heart failure.

Results

Non-cachectic patients showed reduced leg lean tissue (−9·1%,P<0·01) compared to controls. Cachectic patients had significantly reduced lean (−21·0% vs controls, −19·9% vs non-cachectics), fat (−33·0% vs controls, −37·0% vs non-cachectics) and bone tissue (−17·5% vs controls, −15·9% vs non-cachectics) (allP<0·0001). Cachectic patients showed a significantly increased cortisol/dehydroepiandrosterone ratio (+203% vs controls,P<0·0001; +89% vs non-cachectics,P=0·0011) and increased cytokine levels (TNF-α, soluble TNF-receptor 1, interleukin-6). The levels of catabolic hormones and cytokines correlated significantly with reduced muscle and fat tissue content and reduced bone mass.

Conclusion

Peripheral loss of muscle tissue is a general finding in chronic heart failure. The wasting in cardiac cachexia affects all tissue compartments and is significantly related to neurohormonal and immunological abnormalities.