Concurrent depletion of skeletal muscle, fat, and left ventricular mass in patients with cirrhosis of the liver

Evidence for cardiac atrophy has now been demonstrated multiple times in animal models of cancer cachexia1; however, prospective clinical studies to detect an active process of cardiac atrophy in patients with cachexia have not yet been undertaken. Nevertheless if this were to occur, it would be expected that in patients with diseases associated with cachexia, a very low cardiac mass would coincide with the presence of severe skeletal muscle depletion (i.e. sarcopenia) as well as depletion of the fat mass. To test this conjecture, we evaluated left ventricular mass (LVM) determined by echocardiography and body composition [skeletal muscle (SM) and total adipose tissue (TAT)] by computed tomography (CT) cross‐sectional images at the level of the third lumbar vertebra,2 in a population of patients with liver cirrhosis, 50% of whom had concurrent hepatocellular carcinoma (n = 100). These patients were candidates for liver transplantation and had routine evaluations with echocardiography and CT, from which LVM and body composition can be derived. Cirrhotic patients are at risk for weight loss and sarcopenia, which associate with mortality.2, 3 Cross‐sectional areas of SM and TAT were used to calculate estimated total body fat free mass (FFM) and fat mass (FM), respectively.4 All parameters (SM, TAT, FFM, FM) were normalized for stature (divided by height in m2). Patients were categorized based on LVM/height2 (LVMI): Low LVMI (>1 SD below gender‐specific mean value, n = 17), Average LVMI (within ±1 SD of gender‐specific mean value, n = 66), and High LVMI (>1 SD above gender‐specific mean value, n = 17) (Table 1). Table 1 Distribution of left ventricular mass index and cachexia characteristics As patients were candidates for a major surgery (liver transplantation), all of them presented with normal left ventricular ejection fraction (>50%), and none showed any echocardiographic evidence of myocardial infarction or severe valvular disease. Mean age, gender distribution, diastolic dysfunction, main aetiology of cirrhosis, serum creatinine, albumin, and bilirubin, and prevalence of HCC were not different among the three groups (Low, Average, and High LVMI) (Table 1). Low LVMI group included individuals with absolute LVM ranging from 57 to 124 g (♂) and 88–112 g (♀). Overall sarcopenia 2 was more prevalent in patients with Low LVMI compared to the patients with Average LVMI (70.6% vs. 27.3%; HR = 6.4; 95% CI, 1.9–20.7; p = 0.002). Five (29%) patients in the Low LVMI group were extremely sarcopenic (SMI <39 cm2/m2 ♂ and SMI <34 cm2/m2 ♀, while only two (3%) of patients with Average LVMI group were extremely sarcopenic (p = 0.003, Fisher's Exact Test). Fat depletion (TAT index

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