Clinical and echocardiographic phenotype of cardiac wasting in patients with advanced cancer

Markus S Anker^{1

2

3

4}, Muhammad Shahzeb Khan^{5

6

7}, Anja Nikolski^{1

2

3

8}, Jan Porthun^{1

8

9}, Muhammad Sameer Arshad¹⁰, Sara Hadzibegovic^{1

2

3}, Alessia Lena^{1

2

3}, Lucie Kretzler^{1

8}, Jonathan L Hella^{1

2

3

8}, Marco Witkowski^{1

3

11}, Kathrin Rieger^{12

13}, Johann Ahn^{12

13}, Dominik P Modest^{12

13}, Ulrich Keller^{12

13

14

15}, Lars Bullinger^{12

13

14

15}, Matthias Totzeck¹⁵, Amir A Mahabadi¹⁶, Tienush Rassaf¹⁶, Nikolaus Buchmann^{1

3}, Philipp Attanasio^{1

3}, Tanja Zeller^{17

18}, Mahir Karakas^{17

19}, Carlo G Tocchetti^{20

21}, Ursula Wilkenshoff^{1

3

22}, John G F Cleland⁴, Stephan von Haehling^{23

24}, Javed Butler^#^{25

26}, Ulf Landmesser^#^{1

2

3

22}

Affiliations

¹ Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany.
² German Centre for Cardiovascular Research partner site Berlin, and Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany.
³ Department of Cardiology, Angiology and Intensive Care Medicine CBF, German Heart Center Charité, Berlin, Germany.
⁴ School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
⁵ Baylor Scott and White Heart Hospital, Plano, Texas, USA.
⁶ Baylor College of Medicine, Temple, Texas, USA.
⁷ Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, Texas, USA.
⁸ Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany.
⁹ Norwegian University of Science and Technology, Gjøvik, Norway.
¹⁰ Dow University of Health Sciences, Karachi, Pakistan.
¹¹ Friede Springer Cardiovascular Prevention Center at Charité, Charité University Medicine Berlin, Berlin, Germany.
¹² Department of Hematology, Oncology and Cancer Immunology, Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt University Berlin, Berlin, Germany.
¹³ German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹⁴ Max Delbrück Center, Berlin, Germany.
¹⁵ National Center for Tumor Diseases (NCT), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹⁶ Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany.
¹⁷ German Center for Cardiovascular Research (DZHK e.V.) partner site Hamburg/Lübeck/Kiel, Hamburg, Germany.
¹⁸ University Heart Center Hamburg, Clinic of General and Interventional Cardiology, Hamburg, Germany.
¹⁹ Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
²⁰ Cardio-Pulmonary Onco-Immunology, Department of Internal Medicine and Clinical Complexity, Department of Translational Medical Sciences (DISMET), Federico II University, Naples, Italy.
²¹ Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy.
²² Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany.
²³ Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.
²⁴ German Centre for Cardiovascular Research (DZHK) partner site, Lower Saxony, Germany.
²⁵ Baylor Scott and White Research Institute, Dallas, TX, USA.
²⁶ University of Mississippi, Jackson University of Mississippi, Jackson, MS, USA.

^# Contributed equally.

PMID: 40767389
DOI: 10.1002/ejhf.3744

Clinical and echocardiographic phenotype of cardiac wasting in patients with advanced cancer

Markus S Anker et al. Eur J Heart Fail. 2025.

. 2025 Aug 6.

doi: 10.1002/ejhf.3744. Online ahead of print.

Authors

Affiliations

¹ Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt-University Berlin, Berlin, Germany.
² German Centre for Cardiovascular Research partner site Berlin, and Berlin Institute of Health Center for Regenerative Therapies, Berlin, Germany.
³ Department of Cardiology, Angiology and Intensive Care Medicine CBF, German Heart Center Charité, Berlin, Germany.
⁴ School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK.
⁵ Baylor Scott and White Heart Hospital, Plano, Texas, USA.
⁶ Baylor College of Medicine, Temple, Texas, USA.
⁷ Baylor Scott and White Research Institute, Baylor Scott and White Health, Dallas, Texas, USA.
⁸ Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow Clinic, German Heart Center Charité, Berlin, Germany.
⁹ Norwegian University of Science and Technology, Gjøvik, Norway.
¹⁰ Dow University of Health Sciences, Karachi, Pakistan.
¹¹ Friede Springer Cardiovascular Prevention Center at Charité, Charité University Medicine Berlin, Berlin, Germany.
¹² Department of Hematology, Oncology and Cancer Immunology, Charité - University Medicine Berlin corporate member of Free University Berlin and Humboldt University Berlin, Berlin, Germany.
¹³ German Cancer Consortium (DKTK), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹⁴ Max Delbrück Center, Berlin, Germany.
¹⁵ National Center for Tumor Diseases (NCT), partner site Berlin, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
¹⁶ Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany.
¹⁷ German Center for Cardiovascular Research (DZHK e.V.) partner site Hamburg/Lübeck/Kiel, Hamburg, Germany.
¹⁸ University Heart Center Hamburg, Clinic of General and Interventional Cardiology, Hamburg, Germany.
¹⁹ Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
²⁰ Cardio-Pulmonary Onco-Immunology, Department of Internal Medicine and Clinical Complexity, Department of Translational Medical Sciences (DISMET), Federico II University, Naples, Italy.
²¹ Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy.
²² Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany.
²³ Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.
²⁴ German Centre for Cardiovascular Research (DZHK) partner site, Lower Saxony, Germany.
²⁵ Baylor Scott and White Research Institute, Dallas, TX, USA.
²⁶ University of Mississippi, Jackson University of Mississippi, Jackson, MS, USA.

^# Contributed equally.

PMID: 40767389
DOI: 10.1002/ejhf.3744

Abstract

Aims: Cardiac wasting-associated cardiomyopathy in patients with advanced cancer is characterized by loss of left ventricular (LV) mass and independently associated with poor prognosis. Better understanding of this very prevalent cardiomyopathy is urgently needed.

Methods and results: Overall, 398 patients with active, mostly advanced cancer without significant cardiovascular disease (mean LV ejection fraction [LVEF] 64.3 ± 0.2%) or active infection were prospectively examined (mean age 60 ± 1 years, 50% women, body mass index 25.0 ± 0.2 kg/m², 26% cachectic). Patients were categorized and compared by quartiles of LV mass/height². LVEF, global longitudinal strain (GLS), and anticancer therapy naive status were similar across quartiles. Patients in Q1 (lowest LV mass quartile) were younger, more likely cachectic, had lower: BMI, 10-step stair-climbing power, tricuspid annular plane systolic excursion (TAPSE), stroke volume, cardiac output, and higher heart rate. In repeat follow-up assessments after 140 ± 8 days (n = 143), LVEF, TAPSE, LV mass, left atrial volume, and GLS were found reduced (all p ≤ 0.002). Only in those with above-median LV mass at baseline, cardiac output and heart rate increased during follow-up - in those with below-median LV mass, mitral E/A decreased.

Conclusions: Patients with advanced cancer with low LV mass have a distinct phenotype characterized by lower cardiac chamber volumes, stroke volume, and cardiac output, but normal LVEF and GLS that may be the distinct feature of cardiac wasting-associated cardiomyopathy.

Keywords: Cancer; Cardiac wasting cardiomyopathy; Echocardiography; Left ventricular mass; Pathophysiology.

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References

1. Lena A, Wilkenshoff U, Hadzibegovic S, Anker M. Cardiac wasting in patients with advanced cancer: Investigation of clinical and prognostic correlates in a prospective study. J Card Fail 2023;29:690. https://doi.org/10.1016/j.cardfail.2022.10.358
1. Lena A, Ebner N, Anker MS. Cardiac cachexia. Eur Heart J Suppl 2019;21:L24–L27. https://doi.org/10.1093/eurheartj/suz241
1. Belloum Y, Rannou‐Bekono F, Favier FB. Cancer‐induced cardiac cachexia: Pathogenesis and impact of physical activity (review). Oncol Rep 2017;37:2543–2552. https://doi.org/10.3892/or.2017.5542
1. Rausch V, Sala V, Penna F, Porporato PE, Ghigo A. Understanding the common mechanisms of heart and skeletal muscle wasting in cancer cachexia. Oncogenesis 2021;10:1. https://doi.org/10.1038/s41389‐020‐00288‐6
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Clinical and echocardiographic phenotype of cardiac wasting in patients with advanced cancer

Affiliations

Clinical and echocardiographic phenotype of cardiac wasting in patients with advanced cancer

Authors

Affiliations

Abstract

References

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous