Controversies and Conundrums in Cardiac Cachexia: Key Questions About Wasting in Patients With HFrEF (JACC Heart Failure October 2024)-Article: Controversies and Conundrums in Cardiac Cachexia: Key Questions About Wasting in Patients With HFrEF

Article: Controversies and Conundrums in Cardiac Cachexia: Key Questions About Wasting in Patients With HFrEF

Pdf Summary

The article reviews cardiac cachexia, a condition marked by unintentional weight loss, decreased appetite, and inflammation, commonly found in patients with advanced heart failure with reduced ejection fraction (HFrEF). This condition is independently associated with increased mortality and serves as both a marker and consequence of heart failure. Despite various diagnostic modalities available, the definition and treatment of cardiac cachexia remain unclear. The article proposes expanding the advanced heart failure recognition acronym to C-I-NEED-HELP to better recognize and refer patients for advanced therapies like left ventricular assist devices (LVAD) and heart transplantation.<br /><br />Diagnostic challenges persist due to inconsistencies and limitations of available tools in heart failure populations. Commonly, methods like dual x-ray absorptiometry (DXA) for assessing muscle mass and ultrasound for evaluating skeletal muscle mass need standardization in HF. Emerging techniques like deuterated creatine dilution appear promising but require validation for routine clinical use in HF patients.<br /><br />Potential therapies for cardiac cachexia involve metabolic interventions targeting anabolic-catholic balance, controlling underlying cardiac issues, and nutritional supplementation. However, evidence remains inconclusive regarding the benefits of specific nutritional interventions or expensive pharmacological treatments in managing cardiac cachexia. A combination approach involving exercise, adequate dietary intake, and potentially anti-inflammatory drugs may offer hope.<br /><br />A contentious topic is whether preoperative nutritional optimization of cardiac cachexia before major heart surgeries like HT or LVAD could improve outcomes. While prehabilitation could aid in recovery, the optimal period for intervention is not clear and might delay essential surgery, thus increasing risk.<br /><br />The article underscores the importance of recognizing and addressing cardiac cachexia in HFrEF patients, calls for better diagnostic tools, and emphasizes further research into therapeutic interventions that go beyond conventional heart failure treatments to directly target muscle wasting.

Keywords

cardiac cachexia

heart failure

HFrEF

weight loss

diagnostic challenges

nutritional interventions

LVAD

muscle wasting

prehabilitation

therapeutic interventions