Introduction: Cardiac cachexia is associated with poor prognosis in patients with heart failure (HF). Sympathetic overactivation might be implicated in the development of muscle wasting, considering the recent data that carvedilol significantly reversed body weight (BW) loss in HF patients.
Hypothesis: Sympathetic overactivation promotes BW loss in HF patients with reduced ejection fraction (HFrEF, LVEF<0.45).
Methods: We prospectively evaluated changes in BW in 108 non-edematous HFrEF patients in whom muscle sympathetic nerve activity (MSNA) was measured. MSNA is the multiunit recordings of efferent postganglionic sympathetic nerve activity to skeletal muscle regions. BW loss was considered as significant if weight loss was >5% in 12 months. Combined events were defined as hospitalization due to heart failure and cardiovascular death.
Results: Fourteen percent of the enrolled patients had significant BW loss (n=15). One-year combined event rate was significantly higher in BW loss group (67% vs 13%, p<.0001). At baseline, age, body mass index, and medication did not significantly differ between BW loss group and non-BW loss one. However, NYHA functional class III, women and use of cardiac resynchronization therapy were more common among BW loss group compared with non-BW loss group. MSNA (burst incidence, 80 ± 19 vs. 58 ± 20 bursts/100 beats, p <.0001) as well as plasma BNP level (BNP, 325 ± 170 vs. 207 ± 189 pg/mL, p <.05) was significantly higher in BW loss group than in non-BW loss group. Importantly, MSNA burst incidence had a moderate predictability for significant BW loss by receiver-operating characteristic analysis (area under the curve=0.794). Moreover, multiple regression analyses revealed that MSNA burst incidence was an only independent predictor of the significant BW loss (p=0.046).
Conclusion: Sympathetic overactivation determined by MSNA could predict significant BW loss in HFrEF patients.