Cardiac wasting relevant for clinical outcomes in cancer

Cardiac wasting of the left ventricle occurred frequently in patients with advanced cancer, especially in those with cancer cachexia. Additionally, cardiac wasting was associated with reduced health status and an increase in clinical adverse events in these patients.

“Symptoms of cancer patients match many heart failure (HF) symptoms and cardiovascular death is the second most common cause of death in cancer patients,” started Dr Alessia Lena (Charité Universitätsmedizin Berlin, Germany) her presentation [1,2]. Moreover, cardiac wasting is one of the relevant symptoms in advanced cancer and it was hypothesised that cardiac wasting causes increased stress on the left ventricular (LV) wall, subsequently inducing HF in patients with advanced cancer [3]. The current study included 300 patients with mostly advanced cancer, 60 healthy participants, and 60 patients with chronic HF to assess cardiac wasting through 2D transthoracic echocardiographic measurement of LV mass.

The mean LV mass of cancer patients was lower by 13% compared with healthy participants (177 g vs 203 g; P<0.001). The reduction of LV mass was significantly more pronounced in participants with cachectic cancer than in non-cachectic cancer controls (153 g vs 187 g; P<0.001). These results were irrespective of received anti-cancer therapy, including cardiotoxic and non-cardiotoxic therapies. Furthermore, follow-up data of 3.5 years showed that low LV mass (<151/210 g for women and men) was associated with a 72% increased risk of death (P=0.001). Dr Lena added that the results of this study indicate that adjustment for the body-surface area to assess LV mass should not be used in cancer patients because it masks prognostic information. Finally, participants with a low LV mass/height² were associated with a reduced handgrip strength (P=0.001), less stair-climbing power (P<0.001), and a reduced 6-minute walking distance (P=0.034).

In conclusion, cardiac wasting is a relevant finding in patients with advanced cancer, especially in patients with cachectic cancer, and is associated with poor functional status, increased all-cause mortality, and echocardiographic impairments.

1. Lena A, et al. Clinical and prognostic relevance of cardiac wasting in patients with advanced cancer. Basic & Translational Late-Breaking Science, Heart Failure 2022, 21–24 May, Madrid, Spain.
2. Walsh D, et al. Support Care Cancer. 2000;8(3):175–179.
3. Anker MS, et al. Eur J Heart Fail. 2021;23(1):140–144.

 

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Posted on 28 July, 2022