Von der Herzinsuffizienz zur kardialen Kachexie: Klinik und pathophysiologische Mechanismen

Zusammenfassung

Eine Kachexie entwickelt sich im Verlauf vieler chronischer Krankheiten wie maligner Tumoren, Sepsis, chronischer Herz- oder Niereninsuffizienz, rheumatoider Arthritis oder AIDS. Bei oftmals bereits schlechter Prognose der Grunderkrankung ist das Auftreten einer Kachexie meist nochmals mit einer Erhöhung der Morbidität und Mortalität assoziert. Leider ist die Kachexie noch nicht Bestandteil des alltäglichen Sprachgebrauchs des Klinikers geworden, obwohl ihre klinische Bedeutung kaum zu überschätzen ist. Die Ursachen sind sicherlich in der schwierigen Frage der eindeutigen Definition der Kachexie, aber auch im Fehlen einer spezifischen Therapie zu suchen. Das Ziel dieses Artikels ist es, die klinische Relevanz des Problems Kachexie bei chronischer Herzinsuffizienz aufzuzeigen. Darüber hinaus diskutieren wir pathophysiologische Mechanismen der Kachexie unter besonderer Beachtung der inflammatorischen Stimuli und der Regulation des Appetits. Einige mögliche Therapieansätze werden diskutiert.

Abstract

Cachexia develops in the course of many chronic diseases such as malign tumours, chronic heart failure, chronic kidney failure, rheumatoid arthritis, or AIDS. In most cases, the development of cachexia worsens morbidity and mortality of the underlying disease. Unfortunately, the term „cachexia” is still not routinely used by clinicians, although the clinical impact of cachexia is difficult to overestimate. The reasons include the difficult question of a uniform definition of cachexia, but also the absence of specific therapies. The aim of this article is to provide an overview of the pathophysiology and potential therapeutic approaches to cachexia in chronic heart failure. We particularly discuss the role of inflammation and the regulation of appetite.

chronische Herzinsuffizienz - kardiale Kachexie - Inflammation - Stoffwechsel - Pathophysiologie

chronic heart failure - cardiac cachexia - inflammation - metabolism - pathophysiology

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