A complex imbalance of different body systems may cause the development of body wasting, with alterations in the body composition. Available evidence suggests that metabolic, neurohormonal, and immune abnormalities play an important role in the pathophysiology of cardiac cachexia. Pittman and Cohen, in 1964, proposed increased catabolism (protein loss) and reduced anabolism due to cellular hypoxia as the principal pathogenic factor . Currently, several further mechanisms are thought to be responsible for the development of cardiac cachexia. These include dietary deficiency, malabsorption/metabolic dysfunction, and loss of nutrients, e.g. via the urinary or digestive tracts . While several recent studies on the metabolic and immunologic changes have provided interesting results in the last few years, the mechanisms behind the transition from heart failure to cardiac cachexia have yet to be clarified completely.
Fig. 1. Weight loss 6% or more and subsequent cumulative mortality in patients with chronic heart failure in the V-HeFT II study. Data from 
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