title: Plasma adiponectin in heart failure with and without cachexia: catabolic signal linking catabolism, symptomatic status, and prognosis.
abstract: OBJECTIVE
  Adiponectin (ADPN) as an adipose tissue hormone contributes to regulation of energy metabolism and body composition and is associated with cardiovascular risk profile parameters. Cardiac cachexia may develop as a result of severe catabolic derangement in chronic heart failure (CHF). We aimed to determinate an abnormal ADPN regulation as a link between catabolic signalling, symptomatic deterioration and poor prognosis.
  
  
  RESULTS
  We measured plasma ADPN in 111 CHF patients (age 65 ± 11, 90% male, left ventricular ejection fraction (LVEF) 36 ± 11%, peak oxygen consumption (peakVO2) 18.1 ± 5.7 l/kg*min, body mass index (BMI) 27 ± 4 kg/m(2), all mean ± standard deviation) and 36 healthy controls of similar age and BMI. Body composition was assessed by dual energy X-ray absorptiometry, insulin sensitivity was evaluated by homoeostasis model assessment, exercise capacity by spiroergometry. Plasma ADPN did not differ between CHF vs. controls (13.5 ± 11.0 vs. 10.5 ± 5.3 mg/l, p > 0.4), but increased stepwise with NYHA functional class (I/II/III: 5.7 ± 1.4/10.7 ± 8.3/19.2 ± 14.0 mg/l, ANOVA p < 0.01). Furthermore, ADPN correlated with VO2 at anaerobic threshold (r = -0.34, p < 0.05). ADPN was highest in cachectic patients (cCHF, 16%) vs. non-cachectic (ncCHF) (18.7 ± 15.0 vs. 12.5 ± 9.9 mg/l; p < 0.05). ADPN indicated mortality risk independently of established prognosticators (HR: 1.04 95% CI: 1.02-1.07; p < 0.0001). ADPN above the mean (13.5 mg/l) was associated with a 3.4 times higher mortality risk in CHF vs. patients with ADPN levels below the mean.
  
  
  CONCLUSIONS
  Circulating ADPN is abnormally regulated in CHF. ADPN may be involved in impaired metabolic signalling linking disease progression, tissue wasting, and poor outcome in CHF.
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Szabó
authors.affiliation: Centre for Stroke Research Berlin, Charite Universitätsmedizin Berlin, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Scherbakov
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Sandek
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Kung
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany.
authors.forename: S
authors.initials: S
authors.lastname: von Haehling
authors.affiliation: Division of Cardiology, University Clinic, Golnik, Slovenia.
authors.forename: M
authors.initials: M
authors.lastname: Lainscak
authors.affiliation: Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: E A
authors.initials: EA
authors.lastname: Jankowska
authors.affiliation: Department of Endocrinology, Diabetes, and Nutritional Medicine, Universitätsmedizin Berlin, Germany.
authors.forename: N
authors.initials: N
authors.lastname: Rudovich
authors.affiliation: Centre for Clinical and Basic Research, IRCCS San Raffaele, Rome, Italy.
authors.forename: S D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: Department of Endocrinology and Internal Medicine & the Medical Research Laboratories, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Frystyk
authors.affiliation: Department of Endocrinology and Internal Medicine & the Medical Research Laboratories, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Flyvbjerg
authors.affiliation: Department of Endocrinology, Diabetes, and Nutritional Medicine, Universitätsmedizin Berlin, Germany.
authors.forename: A F H
authors.initials: AF
authors.lastname: Pfeiffer
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charite Universitätsmedizin Berlin, Germany; Centre for Stroke Research Berlin, Charite Universitätsmedizin Berlin, Germany. Electronic address: wolfram.doehner@charite.de.
authors.forename: W
authors.initials: W
authors.lastname: Doehner
mesh_terms: D015502:Absorptiometry, Photon; D052242:Adiponectin / Q000097:blood*; D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D002100:Cachexia / Q000097:blood* / Q000150:complications; D002908:Chronic Disease; D015444:Exercise; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D007333:Insulin Resistance; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011379:Prognosis; D052243:Resistin / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D052242:Adiponectin; D052243:Resistin
keywords: Adiponectin; Cachexia; Chronic heart failure; Metabolism