Association of altered body composition with cardiac wasting in cancer with and without cardiotoxic therapy

BACKGROUND AND PURPOSE: In advanced cancer, associations among changes in body composition, cardiac wasting and prior cardiotoxic anticancer therapy have not been investigated.

EXPERIMENTAL APPROACH: Using bioelectrical impedance analysis (BIA), body composition was measured in 206 patients with mostly advanced cancer without known cardiovascular disease or infection (stage III/IV: 84%, prior cardiotoxic anticancer therapy: 55%). Left ventricular (LV) mass was assessed by transthoracic echocardiography and grouped by presence of cardiac wasting according to previously established sex-specific thresholds for LV mass adjusted for height2 (<61 g/m2 for women, <57 g/m2 for men). BIA measurements (indexed to height2) included fat mass index (FMI), fat-free mass index (FFMI), skeletal muscle mass index (SMMI), visceral fat index (VFI), total body water index (TBWI) and extracellular water index (ECWI).

KEY RESULTS: Patients with cancer and cardiac wasting (n = 88) were younger (57±15 vs 62±13 years) and more often women (68% vs 29%) compared to those without cardiac wasting (n = 118). Patients with cardiac wasting had significantly lower FMI (-12%), FFMI (-14%), SMMI (-16%), VFI (-46%), TBWI (-13%) and ECWI (-14%). For women, FFMI was significantly associated with LV mass/height2 (r = 0.41) and VFI for men (r = 0.40). In the multivariable linear regression analysis, FFMI was the strongest significant predictor of cardiac wasting, with no significant interaction by sex or previous cardiotoxic therapy.

CONCLUSIONS AND IMPLICATIONS: Cardiac wasting in advanced cancer is associated with lower FFMI and VFI independent of prior cardiotoxic therapy.