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 height 2 (<61 g/m 2 for women, <57 g/m 2 for men). BIA measurements (indexed to height 2 ) 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/height 2 ( 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.