European Journal of Heart Failure Advance Access published online on June 25, 2009
European Journal of Heart Failure, doi:10.1093/eurjhf/hfp088
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Ghrelin resistance occurs in severe heart failure and resolves after heart transplantation
1 Section for Heart Failure, Department of Cardiology, Karolinska University Hospital, N305, 171 76 Stockholm, Sweden
2 Division of Cardiology, Columbia University, New York, NY, USA
3 Institute of Human Nutrition, College of Physicians and Surgeons, Columbia University, New York, NY, USA
4 Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
5 Salisbury University, Salisbury, MD, USA
6 Department of Medicine, Section of Cardiology, Tulane University School of Medicine, New Orleans, LA, USA
* Corresponding author. Tel: +46 8 5177 0000, Fax: +46 8 311 044, Email: lars.lund{at}alumni.duke.edu
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Abstract |
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Aims: Severe heart failure (HF) is often associated with cachexia that reverses post-heart transplantation (HTx) with frequent development of obesity. Ghrelin is a novel appetite-stimulating hormone. The aim was to determine the role of ghrelin in regulating appetite, food intake, and body composition in HF and post-HTx.
Methods and results: We measured serial ghrelin, hunger sensation, caloric intake, and body composition in 12 HF patients awaiting HTx, 12 patients 12.7 ± 8.6 months post-HTx, and 7 controls. Seven of 12 HF patients were followed for longitudinal analysis post-HTx. Body mass index was 23.1 ± 3.1 in HF and 31.5 ± 5.5 post-HTx (P < 0.001). Heart transplantation patients had gained 18.0 ± 7.7 kg since HTx. Ghrelin area under the curve between controlled meals (control: 186 ± 39; HF: 264 ± 71; HTx: 194 ± 47 ng min/mL, P < 0.007) was higher in HF, but test meal caloric intake (control: 1185 ± 650; HF: 391 ± 103; HTx: 831 ± 309 kcal, P < 0.008) was lower in HF. The longitudinal analysis confirmed these findings.
Conclusion: Heart failure may be associated with resistance to the appetite-stimulating effects of ghrelin, which may contribute to cachexia. Heart transplantation may be associated with resolution of ghrelin resistance, which may contribute to weight gain. These findings are preliminary and should be confirmed in larger trials.
Key Words: Ghrelin • Heart failure • Cachexia • Heart transplantation • Weight gain • Appetite
Received April 21, 2009; Revised May 13, 2009; Accepted May 14, 2009
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  A. Beiras-Fernandez, F. Weis, and B. Reichart Ghrelin resistance in heart failure or why failing cardiomyocytes do not produce ghrelin: the same problem? Eur J Heart Fail, November 1, 2009; 11(11): 1111 - 1111. [Full Text] [PDF]
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L. H. Lund, P. Freda, and D. M. Mancini What is the relationship between cardiac and peripheral ghrelin production? Reply Eur J Heart Fail, November 1, 2009; 11(11): 1111 - 1111. [Full Text] [PDF]
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