Wasting of the left ventricle in patients with cardiac cachexia; a cardiovascular magnetic resonance study

Background: The “cachectic heart” has been described as a pathologic decrease in the size and mass of the heart, but no in vivo studies have shown changes in cardiac dimensions or left ventricular (LV) mass over time in chronic heart failure (CHF) associated with body wasting (cardiac cachexia). Cardiovascular magnetic resonance (CMR) has high reproducibility and is more sensitive than other techniques. Methods: CMR studies of LV volumes and mass were performed at baseline and a mean of 15 months later in nine CHF patients with cardiac cachexia and 28 matched CHF controls without cachexia (mass index 23±1 vs. 29±5 kg/m2, P=0.0005). Results: At baseline, LV end-diastolic volume (197±78 vs. 203±65 ml), end-systolic volume (131±75 vs. 126±63 ml), LV mass (213±44 vs. 222±62 g), and LV ejection fraction (38±19% vs. 40±16%) did not differ between cachectic patients and controls (all P>0.10). During follow-up, there was a significant decrease in LV mass in patients with cachexia (−16 g, P<0.05) and a trend to increase in LV mass in patients without cachexia (+7 g, P=0.12, comparison between groups: P=0.010). Conclusions: The direction of changes over time in LV mass differs in CHF patients with cachexia as compared with non-cachectic controls. A significant decrease in LV mass occurs in patients with cardiac cachexia. This study documents in vivo the occurrence of wasting of the left ventricle in patients with CHF who demonstrate general body wasting.