Arq Bras Cardiol abc Arquivos Brasileiros de Cardiologia Arq. Bras. Cardiol. 0066-782X 1678-4170 Sociedade Brasileira de Cardiologia - SBC Ddx5kq54Wq4zgmgz8BhkZtF S0066-782X2018001300048 10.5935/abc.20180121 Short Editorial Adropin and Irisin in Patients with Cardiac Cachexia Mansur Alfredo José Universidade de São Paulo Faculdade de Medicina Hospital das Clínicas São Paulo SP Brazil Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC FMUSP), São Paulo, SP – Brazil Mailing Address: Alfredo José Mansur, Unidade Clínica de Ambulatório Geral - Av. Dr. Enéas de Carvalho Aguiar, 44. CEP 05403-000, São Paulo, SP – Brazil. E-mail - ajmansur@incor.usp.br 7 2018 111 1 48 49 This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Keywords: Heart Failure Adropine Cachexia Prognosis Weight Loss

Cardiological clinical practice involves the care of patients with heart failure who lose weight, which not rarely culminates in cardiac cachexia. The differential diagnosis with other consumptive disorders can lead to an extensive diagnostic investigation.

That has been a theme of interest in the medical literature for decades,1 and its importance remains recognized over time.2-7 Physicians with decades of experience in cardiological clinical practice have noticed that individuals with heart failure due to heart valvular disease gain weight after well-succeeded surgical interventions that reverse heart failure. In other words, heart failure reversion also manifests as weight gain. A recent outpatient clinical observation [Correia GF & Lima NNC, unpublished data] of 36 patients for months has found body weight variation with the current pharmacological treatment for heart failure including betablockers (Figure 1).

Body weight variation in 2 observations.

Different metabolic mechanisms can mediate that clinical manifestation.8,9

In this issue of the Arquivos Brasileiros de Cardiologia, Kalkan et al.10 have added to the studies in the area the results of the research on two proteins that act on the mechanisms of energetic homeostasis – adropin11 and irisin.12 Those authors have found that the concentration of those proteins differed in 44 patients with cachexia (body mass index 19.9; standard deviation 1.12) as compared to that of 42 patients without cachexia (body mass index 29.2; standard deviation 4.25). On multivariate logistic regression, adropin remained associated with cachexia, despite the low hazard ratio.

Some limitations of the study by Kalkan et al.10 were the lack of information about the etiology of heart failure, the small sample size and the lack of log-term follow-up data. Therefore, the results presented, although initial and exploratory, are important, and further studies should be conducted to elucidate the metabolic mechanisms of weight loss in patients with heart failure.

Short Editorial regarding the article: Adropin and Irisin in Patients with Cardiac Cachexia

 References 1 Pittman JG, Cohen P. The pathogenesis of cardiac cachexia. N Engl J Med. 1964 Aug 20;271:403-9. Pittman JG Cohen P The pathogenesis of cardiac cachexia N Engl J Med 1964 08 20 271 403 409 2 Velloso LG, Csengeri LF, Alonso RR, Ciscato CM, Barreto AC, Bellotti G, et al. [Malnutrition in dilated cardiomyopathy. Correlation with echocardiographic indices of left ventricular function]. Arq Bras Cardiol. 1992;58(3):189-92. Velloso LG Csengeri LF Alonso RR Ciscato CM Barreto AC Bellotti G Malnutrition in dilated cardiomyopathy. Correlation with echocardiographic indices of left ventricular function Arq Bras Cardiol 1992 58 3 189 192 3 Anker SD, Negassa A, Coats AJ, Afzal R, Poole-Wilson PA, Cohn JN, et al. Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study. Lancet. 2003;361(9363):1077-83. Anker SD Negassa A Coats AJ Afzal R Poole-Wilson PA Cohn JN Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study Lancet 2003 361 9363 1077 1083 4 Veloso LG, de Oliveira MT Jr, Munhoz RT, Morgado PC, Ramires JA, Barretto AC. [Nutritional repercussion in advanced heart failure and its value in prognostic assessment]. Arq Bras Cardiol. 2005;84(6):480-5. Veloso LG de Oliveira MT Jr Munhoz RT Morgado PC Ramires JA Barretto AC Nutritional repercussion in advanced heart failure and its value in prognostic assessment Arq Bras Cardiol 2005 84 6 480 485 5 Veloso LG, Pereira-Barretto AC, de Oliveira MT Jr, Munhoz RT, Morgado PC, Ramires JA. [Score for nutritional status evaluation: the role played in the prognostic stratification of dilated cardiomyopathy and advanced heart failure patients]. Arq Bras Cardiol. 2006;87(2):178-84. Veloso LG Pereira-Barretto AC de Oliveira MT Jr Munhoz RT Morgado PC Ramires JA Score for nutritional status evaluation: the role played in the prognostic stratification of dilated cardiomyopathy and advanced heart failure patients Arq Bras Cardiol 2006 87 2 178 184 6 Okoshi MP, Capalbo RV, Romeiro FG, Okoshi K. Cardiac cachexia: perspectives for prevention and treatment. Arq Bras Cardiol. 2017;108(1):74-80. Okoshi MP Capalbo RV Romeiro FG Okoshi K Cardiac cachexia: perspectives for prevention and treatment Arq Bras Cardiol 2017 108 1 74 80 7 Coats AJ. Cardiac cachexia: a window to the wasting disorders cardiac cachexia (letter) Arq Bras Cardiol. 2018;110(1):102-3. Coats AJ Cardiac cachexia: a window to the wasting disorders cardiac cachexia (letter) Arq Bras Cardiol 2018 110 1 102 103 8 von Haehling S, Lainscak M, Springer J, Anker SD. Cardiac cachexia: a systematic overview. Pharmacol Ther. 2009;121(3):227-52. von Haehling S Lainscak M Springer J Anker SD Cardiac cachexia: a systematic overview Pharmacol Ther 2009 121 3 227 252 9 von Haehling S, Anker SD. Treatment of cachexia: an overview of recent developments. Int J Cardiol. 2015 Apr 1;184:736-42. von Haehling S Anker SD Treatment of cachexia: an overview of recent developments Int J Cardiol 2015 04 01 184 736 742 10 Kalkan AK, Cakmak HA, Erturk M, Kalban KE, Uzun F, Tasbulak O, et al. Adropina e irisina em pacientes com caquexia cardíaca. Arq Bras Cardiol. 2018; 111(1):39-47. Kalkan AK Cakmak HA Erturk M Kalban KE Uzun F Tasbulak O Adropina e irisina em pacientes com caquexia cardíaca Arq Bras Cardiol 2018 111 1 39 47 11 Lovren F, Pan Y, Quan A, Singh KK, Shukla PC, Gupta M, et al. Adropin is a novel regulator of endothelial function. Circulation. 2010;122(11 Suppl):S185-92. Lovren F Pan Y Quan A Singh KK Shukla PC Gupta M Adropin is a novel regulator of endothelial function Circulation 2010 122 11 Suppl S185 S192 12 Rodrigues KC, Pereira RM, de Campos TD, de Moura RF, da Silva AS, Cintra DE, et al. The role of physical exercise to improve the browning of white adipose tissue via POMC Neurons. Front Cell Neurosci. 2018 Mar 28;12:88. References Rodrigues KC Pereira RM de Campos TD de Moura RF da Silva AS Cintra DE The role of physical exercise to improve the browning of white adipose tissue via POMC Neurons Front Cell Neurosci 28 03 2018 12 88 88 References Minieditorial Adropina e Irisina em Pacientes com Caquexia Cardíaca Mansur Alfredo José Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC FMUSP), São Paulo, SP – Brasil Correspondência: Alfredo José Mansur, Unidade Clínica de Ambulatório Geral - Av. Dr. Enéas de Carvalho Aguiar, 44. CEP 05403-000, São Paulo, SP – Brasil. E-mail - ajmansur@incor.usp.br Palavras-chave: Insuficiência Cardíaca Adropina Caquexia Prognóstico Perda de Peso

Cardiologistas que atuam na prática clínica cuidam de pacientes com insuficiência cardíaca que perdem peso e não raramente culminam na condição denominada caquexia cardíaca. Por vezes, o diagnóstico diferencial com outras doenças consumptivas pode levar a extensa investigação diagnóstica.

O tema é de interesse na literatura médica há décadas1 e sua importância permanece reconhecida no decorrer do tempo.2-7 Médicos que tiveram a oportunidade de décadas de observação notaram nos portadores de insuficiência cardíaca por doenças valvares o ganho de peso depois de intervenções cirúrgicas bem-sucedidas que revertiam a insuficiência cardíaca. Em outras palavras, a reversão da insuficiência cardíaca manifestava-se também no ganho de peso. Observação clínica ambulatorial recente [Correia GF & Lima NNC, dados não publicados] em 36 pacientes no decorrer de meses verificou a variação do peso corpóreo com o tratamento medicamentoso atual incluindo os betabloqueadores (Figura 1).

Variação de peso corporal entre 2 observações.

Diferentes mecanismos metabólicos podem ser mediadores dessa manifestação clínica.8,9

Neste fascículo dos Arquivos Brasileiros de Cardiologia, Kalkan et al.,10 acrescentam aos estudos na área o resultado da pesquisa de duas proteínas que atuam nos mecanismos de homeostase energética – a adropina11 e a irisina.12 Verificaram que a concentração das proteínas diferiu entre os 44 pacientes com caquexia (índice de massa corpórea 19,9; desvio-padrão 1,12) em relação aos 42 pacientes sem caquexia (índice de massa corpórea 29,2; desvio-padrão 4,25). Na regressão logística multivariada, a adropina permaneceu associada à caquexia, ainda que com uma baixa razão de risco.

Entre as limitações do estudo de Kalkan et al.,10 podemos citar a etiologia não informada da insuficiência cardíaca, casuística pequena e ausência de dados de seguimento no longo prazo, de modo que os resultados apresentados são importantes, mas iniciais, exploratórios e podem ser desenvolvidos em estudos adicionais e contribuir para o entendimento dos mecanismos metabólicos da perda de peso em pacientes com insuficiência cardíaca.

Minieditorial referente ao artigo: Adropina e Irisina em Pacientes com Caquexia Cardíaca