title: Intestinal congestion and right ventricular dysfunction: a link with appetite loss, inflammation, and cachexia in chronic heart failure.
abstract: Mechanisms leading to cachexia in heart failure (HF) are not fully understood. We evaluated signs of intestinal congestion in patients with chronic HF and their relationship with cachexia.
  
  
  
  Of the 165 prospectively enrolled outpatients with left ventricular ejection fraction ≤40%, 29 (18%) were cachectic. Among echocardiographic parameters, the combination of right ventricular dysfunction and elevated right atrial pressure (RAP) provided the best discrimination between cachectic and non-cachectic patients [area under the curve 0.892, 95% confidence interval (CI): 0.832-0.936]. Cachectic patients, compared with non-cachectic, had higher prevalence of postprandial fullness, appetite loss, and abdominal discomfort. Abdominal ultrasound showed a larger bowel wall thickness (BWT) in the entire colon and terminal ileum in cachectic than in non-cachectic patients. Bowel wall thickness correlated positively with gastrointestinal symptoms, high-sensitivity C-reactive protein, RAP, and truncal fat-free mass, the latter serving as a marker of the fluid content. Logistic regression analysis showed that BWT was associated with cachexia, even after adjusting for cardiac function, inflammation, and stages of HF (odds ratio 1.4, 95% CI: 1.0-1.8; P-value = 0.03). Among the cardiac parameters, only RAP remained significantly associated with cachexia after multivariable adjustment.
  
  
  
  Cardiac cachexia was associated with intestinal congestion irrespective of HF stage and cardiac function. Gastrointestinal discomfort, appetite loss, and pro-inflammatory activation provide probable mechanisms, by which intestinal congestion may trigger cardiac cachexia. However, our results are preliminary and larger studies are needed to clarify the intrinsic nature of this relationship.
authors: Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany First Department of Internal Medicine, Comenius University, Bratislava, Slovakia miroslava.valentova@med.uni-goettingen.de.
authors: Miroslava
authors: M
authors: Valentova
authors: Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany.
authors: Stephan
authors: S
authors: von Haehling
authors: Department of Gastroenterology, Charité Medical School, Campus Mitte, Berlin, Germany Center for Internal Medicine, Helios Clinic Zerbst/Anhalt, Zerbst, Germany.
authors: Juergen
authors: J
authors: Bauditz
authors: Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany.
authors: Wolfram
authors: W
authors: Doehner
authors: Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.
authors: Nicole
authors: N
authors: Ebner
authors: Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.
authors: Tarek
authors: T
authors: Bekfani
authors: Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.
authors: Sebastian
authors: S
authors: Elsner
authors: Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.
authors: Veronika
authors: V
authors: Sliziuk
authors: Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany.
authors: Nadja
authors: N
authors: Scherbakov
authors: First Department of Internal Medicine, Comenius University, Bratislava, Slovakia.
authors: Ján
authors: J
authors: Murín
authors: Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany.
authors: Stefan D
authors: SD
authors: Anker
authors: Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Goettingen, Germany.
authors: Anja
authors: A
authors: Sandek
mesh_terms: D000368:Aged; D002100:Cachexia / Q000209:etiology*; D002908:Chronic Disease; D003092:Colitis / Q000473:pathology; D003106:Colon / Q000473:pathology; D001068:Feeding and Eating Disorders / Q000150:complications*; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications* / Q000473:pathology; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D007079:Ileitis / Q000473:pathology; D007082:Ileum / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018497:Ventricular Dysfunction, Right / Q000150:complications*; D017725:Ventricular Pressure / Q000502:physiology
keywords: Cachexia; Heart failure; Intestinal congestion; Right ventricular function