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Clinical and Prognostic Relevance of Cardiac Wasting in Patients With Advanced Cancer

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Clinical and Prognostic Relevance of Cardiac Wasting in Patients With Advanced Cancer. / Lena, Alessia; Wilkenshoff, Ursula; Hadzibegovic, Sara; Porthun, Jan; Rösnick, Lukas; Fröhlich, Ann-Kathrin; Zeller, Tanja; Karakas, Mahir; Keller, Ulrich; Ahn, Johann; Bullinger, Lars; Riess, Hanno; Rosen, Stuart D; Lyon, Alexander R; Lüscher, Thomas F; Totzeck, Matthias; Rassaf, Tienush; Burkhoff, Daniel; Mehra, Mandeep R; Bax, Jeroen J; Butler, Javed; Edelmann, Frank; Haverkamp, Wilhelm; Anker, Stefan D; Packer, Milton; Coats, Andrew J S; von Haehling, Stephan; Landmesser, Ulf; Anker, Markus S.

In: J AM COLL CARDIOL, Vol. 81, No. 16, 25.04.2023, p. 1569-1586.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Lena, A, Wilkenshoff, U, Hadzibegovic, S, Porthun, J, Rösnick, L, Fröhlich, A-K, Zeller, T, Karakas, M, Keller, U, Ahn, J, Bullinger, L, Riess, H, Rosen, SD, Lyon, AR, Lüscher, TF, Totzeck, M, Rassaf, T, Burkhoff, D, Mehra, MR, Bax, JJ, Butler, J, Edelmann, F, Haverkamp, W, Anker, SD, Packer, M, Coats, AJS, von Haehling, S, Landmesser, U & Anker, MS 2023, 'Clinical and Prognostic Relevance of Cardiac Wasting in Patients With Advanced Cancer', J AM COLL CARDIOL, vol. 81, no. 16, pp. 1569-1586. https://doi.org/10.1016/j.jacc.2023.02.039

APA

Lena, A., Wilkenshoff, U., Hadzibegovic, S., Porthun, J., Rösnick, L., Fröhlich, A-K., Zeller, T., Karakas, M., Keller, U., Ahn, J., Bullinger, L., Riess, H., Rosen, S. D., Lyon, A. R., Lüscher, T. F., Totzeck, M., Rassaf, T., Burkhoff, D., Mehra, M. R., ... Anker, M. S. (2023). Clinical and Prognostic Relevance of Cardiac Wasting in Patients With Advanced Cancer. J AM COLL CARDIOL, 81(16), 1569-1586. https://doi.org/10.1016/j.jacc.2023.02.039

Vancouver

Lena A, Wilkenshoff U, Hadzibegovic S, Porthun J, Rösnick L, Fröhlich A-K et al. Clinical and Prognostic Relevance of Cardiac Wasting in Patients With Advanced Cancer. J AM COLL CARDIOL. 2023 Apr 25;81(16):1569-1586. https://doi.org/10.1016/j.jacc.2023.02.039

Bibtex

@article{a067d72389ec47b9bbefdcfe0a9c4b2f,
title = "Clinical and Prognostic Relevance of Cardiac Wasting in Patients With Advanced Cancer",
abstract = "BACKGROUND: Body wasting in patients with cancer can affect the heart.OBJECTIVES: The frequency, extent, and clinical and prognostic importance of cardiac wasting in cancer patients is unknown.METHODS: This study prospectively enrolled 300 patients with mostly advanced, active cancer but without significant cardiovascular disease or infection. These patients were compared with 60 healthy control subjects and 60 patients with chronic heart failure (ejection fraction <40%) of similar age and sex distribution.RESULTS: Cancer patients presented with lower left ventricular (LV) mass than healthy control subjects or heart failure patients (assessed by transthoracic echocardiography: 177 ± 47 g vs 203 ± 64 g vs 300 ± 71 g, respectively; P < 0.001). LV mass was lowest in cancer patients with cachexia (153 ± 42 g; P < 0.001). Importantly, the presence of low LV mass was independent of previous cardiotoxic anticancer therapy. In 90 cancer patients with a second echocardiogram after 122 ± 71 days, LV mass had declined by 9.3% ± 1.4% (P < 0.001). In cancer patients with cardiac wasting during follow-up, stroke volume decreased (P < 0.001) and resting heart rate increased over time (P = 0.001). During follow-up of on average 16 months, 149 patients died (1-year all-cause mortality 43%; 95% CI: 37%-49%). LV mass and LV mass adjusted for height squared were independent prognostic markers (both P < 0.05). Adjustment of LV mass for body surface area masked the observed survival impact. LV mass below the prognostically relevant cutpoints in cancer was associated with reduced overall functional status and lower physical performance.CONCLUSIONS: Low LV mass is associated with poor functional status and increased all-cause mortality in cancer. These findings provide clinical evidence of cardiac wasting-associated cardiomyopathy in cancer.",
keywords = "Humans, Cachexia/diagnosis, Prognosis, Heart, Heart Failure, Stroke Volume/physiology, Neoplasms/complications, Ventricular Function, Left/physiology",
author = "Alessia Lena and Ursula Wilkenshoff and Sara Hadzibegovic and Jan Porthun and Lukas R{\"o}snick and Ann-Kathrin Fr{\"o}hlich and Tanja Zeller and Mahir Karakas and Ulrich Keller and Johann Ahn and Lars Bullinger and Hanno Riess and Rosen, {Stuart D} and Lyon, {Alexander R} and L{\"u}scher, {Thomas F} and Matthias Totzeck and Tienush Rassaf and Daniel Burkhoff and Mehra, {Mandeep R} and Bax, {Jeroen J} and Javed Butler and Frank Edelmann and Wilhelm Haverkamp and Anker, {Stefan D} and Milton Packer and Coats, {Andrew J S} and {von Haehling}, Stephan and Ulf Landmesser and Anker, {Markus S}",
note = "Copyright {\textcopyright} 2023 The Authors. Published by Elsevier Inc. All rights reserved.",
year = "2023",
month = apr,
day = "25",
doi = "10.1016/j.jacc.2023.02.039",
language = "English",
volume = "81",
pages = "1569--1586",
journal = "J AM COLL CARDIOL",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "16",

}

RIS

TY - JOUR

T1 - Clinical and Prognostic Relevance of Cardiac Wasting in Patients With Advanced Cancer

AU - Lena, Alessia

AU - Wilkenshoff, Ursula

AU - Hadzibegovic, Sara

AU - Porthun, Jan

AU - Rösnick, Lukas

AU - Fröhlich, Ann-Kathrin

AU - Zeller, Tanja

AU - Karakas, Mahir

AU - Keller, Ulrich

AU - Ahn, Johann

AU - Bullinger, Lars

AU - Riess, Hanno

AU - Rosen, Stuart D

AU - Lyon, Alexander R

AU - Lüscher, Thomas F

AU - Totzeck, Matthias

AU - Rassaf, Tienush

AU - Burkhoff, Daniel

AU - Mehra, Mandeep R

AU - Bax, Jeroen J

AU - Butler, Javed

AU - Edelmann, Frank

AU - Haverkamp, Wilhelm

AU - Anker, Stefan D

AU - Packer, Milton

AU - Coats, Andrew J S

AU - von Haehling, Stephan

AU - Landmesser, Ulf

AU - Anker, Markus S

N1 - Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.

PY - 2023/4/25

Y1 - 2023/4/25

N2 - BACKGROUND: Body wasting in patients with cancer can affect the heart.OBJECTIVES: The frequency, extent, and clinical and prognostic importance of cardiac wasting in cancer patients is unknown.METHODS: This study prospectively enrolled 300 patients with mostly advanced, active cancer but without significant cardiovascular disease or infection. These patients were compared with 60 healthy control subjects and 60 patients with chronic heart failure (ejection fraction <40%) of similar age and sex distribution.RESULTS: Cancer patients presented with lower left ventricular (LV) mass than healthy control subjects or heart failure patients (assessed by transthoracic echocardiography: 177 ± 47 g vs 203 ± 64 g vs 300 ± 71 g, respectively; P < 0.001). LV mass was lowest in cancer patients with cachexia (153 ± 42 g; P < 0.001). Importantly, the presence of low LV mass was independent of previous cardiotoxic anticancer therapy. In 90 cancer patients with a second echocardiogram after 122 ± 71 days, LV mass had declined by 9.3% ± 1.4% (P < 0.001). In cancer patients with cardiac wasting during follow-up, stroke volume decreased (P < 0.001) and resting heart rate increased over time (P = 0.001). During follow-up of on average 16 months, 149 patients died (1-year all-cause mortality 43%; 95% CI: 37%-49%). LV mass and LV mass adjusted for height squared were independent prognostic markers (both P < 0.05). Adjustment of LV mass for body surface area masked the observed survival impact. LV mass below the prognostically relevant cutpoints in cancer was associated with reduced overall functional status and lower physical performance.CONCLUSIONS: Low LV mass is associated with poor functional status and increased all-cause mortality in cancer. These findings provide clinical evidence of cardiac wasting-associated cardiomyopathy in cancer.

AB - BACKGROUND: Body wasting in patients with cancer can affect the heart.OBJECTIVES: The frequency, extent, and clinical and prognostic importance of cardiac wasting in cancer patients is unknown.METHODS: This study prospectively enrolled 300 patients with mostly advanced, active cancer but without significant cardiovascular disease or infection. These patients were compared with 60 healthy control subjects and 60 patients with chronic heart failure (ejection fraction <40%) of similar age and sex distribution.RESULTS: Cancer patients presented with lower left ventricular (LV) mass than healthy control subjects or heart failure patients (assessed by transthoracic echocardiography: 177 ± 47 g vs 203 ± 64 g vs 300 ± 71 g, respectively; P < 0.001). LV mass was lowest in cancer patients with cachexia (153 ± 42 g; P < 0.001). Importantly, the presence of low LV mass was independent of previous cardiotoxic anticancer therapy. In 90 cancer patients with a second echocardiogram after 122 ± 71 days, LV mass had declined by 9.3% ± 1.4% (P < 0.001). In cancer patients with cardiac wasting during follow-up, stroke volume decreased (P < 0.001) and resting heart rate increased over time (P = 0.001). During follow-up of on average 16 months, 149 patients died (1-year all-cause mortality 43%; 95% CI: 37%-49%). LV mass and LV mass adjusted for height squared were independent prognostic markers (both P < 0.05). Adjustment of LV mass for body surface area masked the observed survival impact. LV mass below the prognostically relevant cutpoints in cancer was associated with reduced overall functional status and lower physical performance.CONCLUSIONS: Low LV mass is associated with poor functional status and increased all-cause mortality in cancer. These findings provide clinical evidence of cardiac wasting-associated cardiomyopathy in cancer.

KW - Humans

KW - Cachexia/diagnosis

KW - Prognosis

KW - Heart

KW - Heart Failure

KW - Stroke Volume/physiology

KW - Neoplasms/complications

KW - Ventricular Function, Left/physiology

U2 - 10.1016/j.jacc.2023.02.039

DO - 10.1016/j.jacc.2023.02.039

M3 - SCORING: Journal article

C2 - 37076211

VL - 81

SP - 1569

EP - 1586

JO - J AM COLL CARDIOL

JF - J AM COLL CARDIOL

SN - 0735-1097

IS - 16

ER -