Circulating miRNAs Signature as a Predictor of Cachexia in Chronic Heart Failure: Diagnostic and Prognostic Implications

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Cachexia is defined as a complex wasting syndrome characterized by progressive weight loss, muscle wasting and a systemic inflammatory response. The incidence of cachexia in the course of cardiovascular diseases ranges from 8 to 42% depending on the applied diagnostic criteria. In clinical practice, it most commonly accompanies chronic heart failure (CHF) affecting up to 40% of patients [ 1 , 2 ]. The presence of the wasting syndrome negatively impacts patient outcomes, cardiac function, quality of life and survival, thus early identification of patients susceptible to cachexia is a key clinical goal [ 3 ]. It has been proven that systemic inflammation has a fundamental role in the CHF development, progression and its further complications. Moreover, surge in proinflammatory cytokines during CHF, including tumor necrosis factor-alpha (TNF-α), interleukin-1 (IL-1) and interleukin-6 (IL-6) is believed to promote both progressive muscle wasting and adipocyte lipolysis contributing to malnutrition, and eventually cachexia [ 4 ]. Beyond the inflammatory conception, the pathogenesis of cachexia accompanying CHF includes upregulation of the renin-angiotensin-aldosterone system, altered appetite, reduced nutrient absorption, cardiomyocyte dysfunction and diminished myocardial perfusion [ 2 , 5 ].

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