Controversies and Conundrums in Cardiac Cachexia
Open accessAbstract
Cardiac cachexia is characterized by unintentional catabolic weight loss, decreased appetite, and inflammation and is common in patients with stage D (advanced) heart failure with reduced ejection fraction (HFrEF). Cardiac cachexia and related muscle-wasting syndromes are markers of, and a consequence of, the heart failure (HF) syndrome. Although many potential modalities for identifying cardiac cachexia exist, the optimal definition, diagnostic tools, and treatment options for cardiac cachexia remain unclear. Furthermore, it remains unclear whether attempts to reverse muscle wasting prior to advanced HF surgeries, such as left ventricular assist devices and heart transplantation, can improve outcomes. It is important that HF clinicians and dietitians are aware of the pathophysiology and mechanisms of muscle-wasting syndromes in patients with HF, to aid in the recognition and risk stratification of advanced HFrEF. Although the opportunities and rationale for attempting to address cardiac cachexia prior to advanced HF surgeries are uncertain, recent publications suggest that control of the neurohumoral syndrome of advanced HF may be important to permit the recovery of skeletal muscle mass.
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Cardiac cachexia is characterized by catabolic metabolism and accelerated turnover of protein stores, degrading fat-free mass and leading to elevated urine nitrogen excretion.
“Conversely, cardiac cachexia is characterized by a catabolic metabolism and accelerated turnover of protein stores, degrading fat-free mass and leading to elevated urine nitrogen excretion.”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [90]
The pathophysiological basis of cardiac cachexia is thought to stem from complex interplay between neurohormonal dysregulation of advanced heart failure, chronic inflammation, myocardial substrate demands, abnormalities of mesenteric perfusion, and venous pressures, and may be exacerbated by inadequate macronutrient intake.
“The pathophysiological basis of this catabolic state is thought to stem from complex interplay between the neurohormonal dysregulation of the advanced HF (particularly HF with reduced ejection fraction) syndrome, chronic inflammation, myocardial substrate demands of the failing heart, abnormalities of mesenteric perfusion,”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [90]
Higher metabolic demand in critically ill cardiac patients increases cardiac cachexia and sarcopenia risks, often coexisting with malnutrition and frailty, which negatively affects outcomes.
“Moreover, their higher metabolic demand increases cardiac cachexia and sarcopenia risks, often coexisting with malnutrition and frailty, which negatively affects outcomes.19,90”
From Malnutrition and Cachexia in Inpatients With Acute Cardiac Conditions: A Scientific Statement From the American Heart Association (2026) · cites this paper as [90]
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Vest, A. R., DiDomenico, R. J., Lichtenstein, L., Slater, T., Ekpo, E., Damluji, A. A., Bohula, E., Alviar, C. L., on behalf of the American Heart Association Acute Cardiac Care and General Cardiology Committee of the Council on Clinical Cardiology, & Council on Cardiovascular and Stroke Nursing (2026) · Circulation · doi:10.1161/cir.0000000000001405 · Cited by 15 · see citing works
Self-citation
- Authors
- Ilonze, O. J., Parsly Read-Button, L., Cogswell, R., Hackman, A., Breathett, K., Saltzman, E., & Vest, A. R.
- Affiliations
- Indiana University Indianapolis (US)
- University of Minnesota (US)
- Tufts University (US)
- Tufts Medical Center (US)
- Corresponding author
- Vest, Amanda R.
- Venue
- JACC: Heart Failure
- Publisher
- Elsevier BV
- Published
- 2024-10
- Volume
- 12
- Issue
- 10
- Pages
- 1645-1660
- ISSN
- 2213-1779 (ISSN-L)
- OpenAlex
- W4396719393
- Cited by
- 30
- References
- 7
- Citations by year
- 2026: 13 · 2025: 12 · 2024: 5
- FWCI
- 1.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Tufts Medical Center
- Topics
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Keywords
- cardiac cachexia, heart failure with reduced ejection fraction, muscle atrophy, skeletal muscle mass, neurohormonal activation, left ventricular assist device, heart transplantation, inflammation, risk stratification, cachexia treatment
- MeSH terms
- Cachexia, Heart Failure, Humans, Muscular Atrophy, Stroke Volume, Muscle, Skeletal
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