Cytokines and neurohormones relating to body composition alterations in the wasting syndrome of chronic heart failure.
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) (all P<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-alpha, 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.


CONCLUSIONS
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.
Anker
S D
SD
Department of Cardiac Medicine, National Heart and Lung Institute, London, U.K.
Ponikowski
P P
PP
Clark
A L
AL
Leyva
F
F
Rauchhaus
M
M
Kemp
M
M
Teixeira
M M
MM
Hellewell
P G
PG
Hooper
J
J
Poole-Wilson
P A
PA
Coats
A J
AJ
D000328:Adult; D000368:Aged; D001823:Body Composition; D002395:Catecholamines / Q000097:blood; D016207:Cytokines / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D019282:Wasting Syndrome / Q000097:blood* / Q000209:etiology
D002395:Catecholamines; D016207:Cytokines; D007328:Insulin; D006854:Hydrocortisone