心脏萎缩是癌症不良后果，传统上被忽视，经常被误解为治疗性副作用。我们对42位未接受化疗的局部晚期头颈部癌症患者进行了回顾性研究。根据非预期体重减轻，将患者分为虚弱和非虚弱两组。采用超声心动图分析左室质量(LVM)、左室壁厚度(LVWT)、室间隔(IVS)厚度、舒张期左室内径(LVIDd)、收缩期左室内径(LVIDs)、舒张期内室间隔(IVSd)、左心室后壁厚度(LVPWd)和左室射血分数(LVEF)。同时，我们回顾性地分析了28例心脏自发检验标本，这些患者在化疗前或尸解时被诊断为癌症。通过显微观察的心肌纤维化存在或不存在用于样本分层。进行了常规组织学检查。虚弱和非虚弱患者的LVWT，IVS厚度和LVPWd具有显着不同的值。 虚弱和非虚弱患者的LVWT分别为9.08±1.57和10.35±1.41mm （P=0.011），IVS分别为10.00mm（8.50-11.00）和11.00mm（10.00-12.00）（P=0.035），LVPWd分别为9.0（8.5-10.0）和10.00 mm（9.5-11.0）（P=0.019）。经身体表面积或身高平方校正的LVM在两种人群之间没有差异。同样，LVEF没有显示任何显著下降。在多元逻辑回归分析中，对体重减轻的一些独立预测因子，只有LVWT在虚弱和非虚弱患者之间保持显着差异（P=0.035，OR=0.240;P=0.019）。对自动验标本的二次分析显示，心脏重量没有明显变化，而在存在心肌纤维化的心脏标本中，LVWT从9.50（7.25-11.00）降至7.50mm（6.00-9.00）（P=0.043）。多元逻辑回归分析证实了这些数据（P=0.041，OR=0.502）。组织病理学分析证实了心肌细胞严重萎缩、纤维化和水肿，与对照组相比。头颈部癌症患者的心脏结构和功能发生了微妙的变化，这可以通过常规超声心动图检测，并且可以帮助选择适当的癌症治疗方案。 组织病理学分析提供了确凿的证据，证明了癌症进展期间心肌细胞的萎缩、水肿和纤维化，可能先于明显的心脏病理学发生。据我们所知，这是第一项在头颈部癌症中建立肿瘤进展和心脏重塑之间直接关系的临床研究，也是第一项针对选定的未接受化疗的癌症患者进行人体心脏自发检验的病理学研究。© 2023 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.

Cardiac wasting is a detrimental consequence of cancer that has been traditionally ignored and often misinterpreted as an iatrogenic effect.We conducted a retrospective study on 42 chemo-naive patients affected by locally advanced head and neck cancer (HNC). Based on unintentional weight loss, patients were divided into cachectic and non-cachectic. Left ventricular mass (LVM), LV wall thickness (LVWT), interventricular septal (IVS) thickness, left ventricular internal diameter diastolic (LVIDd), left ventricular internal diameter systolic (LVIDs), internal ventricular septum diastolic (IVSd), left ventricular posterior wall thickness diastolic (LVPWd) and LV ejection fraction (LVEF) were analysed by echocardiography. In parallel, we retrospectively analysed 28 cardiac autoptic specimens of patients who either died of cancer before chemotherapy or with a diagnosis of cancer at autopsy. Presence or absence of myocardial fibrosis at microscopic observation was used for sample stratification. Conventional histology was performed.Cachectic and non-cachectic patients had a significantly different value of LVWT and IVS thickness and LVPWd. LVWT was 9.08 ± 1.57 versus 10.35 ± 1.41 mm (P = 0.011) in cachectic and non-cachectic patients, IVS was 10.00 mm (8.50-11.00) versus 11.00 mm (10.00-12.00) (P = 0.035), and LVPWd was 9.0 (8.5-10.0) and 10.00 mm (9.5-11.0) (P = 0.019) in cachectic and non-cachectic patients. LVM adjusted for body surface area or height squared did not differ between the two populations. Similarly, LVEF did not show any significant decline. At multivariate logistic regression analysis for some independent predictors of weight loss, only LVWT maintained significant difference between cachectic and non-cachectic patients (P = 0.035, OR = 0.240; P = 0.019). The secondary analysis on autoptic specimens showed no significant change in heart weight, whereas LVWT declined from 9.50 (7.25-11.00) to 7.50 mm (6.00-9.00) in cardiac specimens with myocardial fibrosis (P = 0.043). These data were confirmed in multivariate logistic regression analysis (P = 0.041, OR = 0.502). Histopathological analysis confirmed severe atrophy of cardiomyocytes, fibrosis and oedema as compared with controls.Subtle changes in heart structure and function occur early in HNC patients. These can be detected with routine echocardiography and may help to select appropriate cancer treatment regimens for these patients. Histopathological analysis provided conclusive evidence that atrophy of cardiomyocytes, oedema and fibrosis occur during cancer progression and may precede the onset of overt cardiac pathology. To our knowledge, this is the first clinical study that establishes a direct relationship between tumour progression and cardiac remodelling in HNCs and the first pathological study conducted on human cardiac autopsies from selected chemo-naïve cancer patients.© 2023 The Authors. Journal of Cachexia, Sarcopenia and Muscle published by John Wiley & Sons Ltd on behalf of Society on Sarcopenia, Cachexia and Wasting Disorders.