Heart 1999;82:352-356 ( September )

Inappropriately low plasma leptin concentration in the cachexia associated with chronic heart failure

D R Murdoch^a, E Rooney^b, H J Dargie^a, D Shapiro^c, J J Morton^b, J J V McMurray^a

^a Department of Cardiology, Western Infirmary, Dumbarton Road, Glasgow G11 6NT, UK, ^b Clinical Research Initiative in Heart Failure, Supported by the Medical Research Council, University of Glasgow, UK, ^c Department of Biochemistry, Gartnavel General Hospital, Glasgow, UK

Correspondence to: Dr Murdoch. email: drm2x{at}udcf.gla.ac.uk

Accepted for publication 18 March 1999

BACKGROUNDCardiac cachexia is a syndrome of generalised wasting which caries a poor prognosis and is associated with raised plasma concentrations of tumour necrosis factor  (TNF). TNF increases secretion of leptin, a hormone which decreases food intake and increases energy expenditure.
OBJECTIVETo determine whether an inappropriate increase in plasma leptin concentration contributes to the cachexia of chronic heart failure.
DESIGNRetrospective case-control study.
SETTINGTertiary referral cardiology unit.
PATIENTS110 human subjects comprising 29 cachectic chronic heart failure patients, 22 non-cachectic chronic heart failure patients, 33 patients with ischaemic heart disease but normal ventricular function, and 26 healthy controls.
INTERVENTIONSMeasurement of: body fat content by skinfold thickness (cachectic males < 27%, females < 29%); plasma leptin, TNF, and noradrenaline (norepinephrine); central haemodynamics in chronic heart failure patients at right heart catheterisation.
MAIN OUTCOME MEASURESPlasma leptin concentration corrected for body fat content, plasma TNF and noradrenaline concentration, and central haemodynamics.
RESULTSMean (SEM) plasma leptin concentrations were: 6.2 (0.6) ng/ml (cachectic heart failure), 16.9 (3.6) ng/ml (non-cachectic heart failure), 16.8 (3.0) ng/ml (ischaemic heart disease), and 18.3 (3.5) ng/ml (control) (p < 0.001 for cachectic heart failure v all other groups). Plasma leptin concentration remained significantly lower in the cachectic heart failure group even after correcting for body fat content and in spite of significantly increased TNF concentrations. Thus plasma leptin was inappropriately low in cachectic chronic heart failure in the face of a recognised stimulus to its secretion. There was no significant correlation between plasma leptin, New York Heart Association class, ejection fraction, or any haemodynamic indices.
CONCLUSIONSLeptin does not contribute to the cachexia of chronic heart failure. One or more leptin suppressing mechanisms may operate in this syndromefor example, the sympathetic nervous system.


Keywords: heart failure; cytokines; leptin; cachexia

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© 1999 by Heart
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