Anthropometric variables and physical activity as predictors of cardiac cachexia.

BACKGROUND: This study explored the frequency of cardiac cachexia in Mexican patients, the role of anthropometric variables as predictors of its development and its association with food intake and physical activity. METHODS: Seventy three patients with systolic heart failure were included in the study. Cardiac cachexia was defined as weight loss of >6.0% in 6 months. Anthropometric data, physical activity and dietary intake were evaluated by a 3-day questionnaire at the beginning of the study and 6 months later. RESULTS: After 6 months of follow up, 14 (19%) patients developed cachexia with a mean weight loss of 12.1+/-3.4%. Significant decrease in the anthropometric variables were observed in patients which developed cachexia except in the waist to hip ratio, which increased in these patients due to bigger diminish of hip circumference than in the waist one. The subjects which developed cachexia had significant less physical activity after 6 months (-6.9%) in comparison with the non cachexic group. Reported energy intake did no differ among groups. Patients with cardiac cachexia showed greater prevalence of obesity and overweight, a high body fat percentage and a low arm circumference. CONCLUSIONS: Cardiac cachexia development was not related with low energy intake or increase in the total energy expenditure (explained by the physical activity). The only variable related to cachexia development was lower physical activity.

Response to treatment during medium-term follow-up in a series of patients with neurocardiogenic syncope.

BACKGROUND: Syncope is a common symptom that has different recurrence ratios. We hypothesized that an individualized treatment regimen including pharmacologic and nonpharmacologic measures considering kind of neurocardiogenic syncope (NCS) and basal characteristics of each patient could allow optimized therapy to avoid recurrences. METHODS: We conducted a prospective study to evaluate performance of diverse accepted treatments for NCS. Each patient received specific treatment including general measures such as an increase in salt and water intake, tilt training, specific pharmacologic treatment according to head-up tilt table test (HUTT) result, and patient basal blood pressure and heart rate measurements. RESULTS: We followed a group of 127 patients during a main period of 20.8 +/- 9 months (range, 6-38 months). Mean age was 47.8 +/- 19.2 years and 66.9% were females. We had six (4.7%) patients with recurrence of symptoms 4 +/- 0.9 months after diagnostic HUTT. Medications used were atenolol in 20 patients, pindolol in 17, dysopiramide in 50, and fluoxetine in 25. Two patients received fludrocortisone. Tilt training was not indicated initially for patients with recurrences but was indicated later; to date, these patients have not experienced further episodes. CONCLUSIONS: Increase in water and salt intake, as well as tilt training, showed great value in prevention of syncope recurrences in this specific set of patients. Pharmacologic treatment has an important role, but there is no single medication associated with significant improvement in symptom control.