HORMONAL CHANGES AND CATABOLIC ANABOLIC IMBALANCE IN CHRONIC HEART-FAILURE AND THEIR IMPORTANCE FOR CARDIAC CACHEXIA/

Background The role of hormonal and cytokine abnormalities in the deve lopment of cardiac cachexia remains obscure. Methods and Results Healt hy control subjects (n=16) and patients with chronic heart failure (CH F), classified clinically as cachectic (8% to 35% weight loss over gre ater than or equal to 6 months before study, n=16) or noncachectic (n= 37), were assessed for markers of disease severity (maximal oxygen con sumption, left ventricular ejection fraction, NYHA functional class). These markers were compared with plasma concentrations of potentially important anabolic and catabolic factors. The degree of neurohormonal activation and catabolic/anabolic imbalance was closely related to was ting but not to conventional measures of the severity of heart failure . Compared with control subjects and noncachectic patients, cachectic patients had reduced plasma sodium and increased norepinephrine, epine phrine (all P<.0001), cortisol,tumor necrosis factor (TNF)-alpha (both P<.002), and human growth hormone (P<.05). Insulin-like growth factor -1, testosterone, and estrogen were similar in all groups. Insulin was increased only in the noncachectic patients (P<.005 versus control su bjects). Dehydroepiandrosterone was reduced in the cachectic patients (P<.02 versus control subjects). Insulin, cortisol, TNF-alpha, and nor epinephrine correlated independently with wasting in CHF (P<.05; multi ple regression of these four factors versus percent ideal weight, R-2= .50, P<.0001). Conclusions Cachexia is more closely associated with ho rmonal changes in CHF than conventional measures of the severity of CH F. This study suggests that the syndrome of heart failure progresses t o cardiac cachexia if the normal metabolic balance between catabolism and anabolism is altered.