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Spina G, Clemente A, Roversi M, Marchili MR, Silvestri P, Mascolo C, Zanna V, Diamanti A, Reale A, Villani A, Raucci U, Ammirati A. Early echocardiographic evaluation of children admitted to the emergency department for anorexia nervosa during the COVID-19 pandemic. Eat Weight Disord 2022; 27:3409-3417. [PMID: 36053460 PMCID: PMC9438386 DOI: 10.1007/s40519-022-01474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/21/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Anorexia nervosa (AN) is the most frequent eating disorder (ED), whose cardiac complications may have life-threatening consequences for both the physical and psychological health of affected children. In this study, we reported and analysed the echocardiographic anomalies found in pediatric patients diagnosed with AN. METHODS We reported the demographic and clinical characteristics of children aged 8 to 18 years, who were diagnosed with AN and underwent a complete cardiological evaluation at the Emergency Department of the Bambino Gesù Children's Hospital, IRCCS, Rome between the 1st January 2021 and the 30th June 2021. Furthermore, we compared the patients according to the presence of pericardial effusion and a BMI (body mass index) cut-off 14.5 kg/m2. RESULTS Forty-nine patients were included in the study. The mean age was 15.1 years. Most patients were female (89.8%). The mean length of hospitalization was 18 days. The mean BMI at admission was 14.8 kg/m2, with a median weight loss of 9 kg in the last year. Eleven patients (22.4%) presented with cardiovascular signs or symptoms at admission. Most patients had pericardial effusion on heart ultrasound, with a mean thickness of 6 mm (SD ± 4). The LV (left ventricle) thickness over age was significantly higher in patients with pericardial effusion, with a Z score of -2.0 vs -1.4 (p = 0.014). The administration of psychiatric drugs was significantly more frequent in patients with a lower BMI (37.5% vs 12%, p = 0.038). CONCLUSION Our study suggests that a non-urgent baseline echocardiographic evaluation with focus on left-ventricular wall thickness and mass in children with anorexia nervosa is advisable. LEVEL III Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Giulia Spina
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Clemente
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Roversi
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Maria Rosaria Marchili
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Silvestri
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristina Mascolo
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Valeria Zanna
- Anorexia Nervosa and Eating Disorders Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Antonella Diamanti
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Antonio Ammirati
- Consultant Cardiologist at Pediatric Emergency Unit, Department of Emergency, Acceptance and General Pediatrics, Pediatric Emergency Department, Bambino Gesù Children's Hospital, Rome, Italy
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Echocardiographic Evidence of Cardiac Atrophy in the Critically Ill. Crit Care Explor 2022; 4:e0804. [PMID: 36419634 PMCID: PMC9678529 DOI: 10.1097/cce.0000000000000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
UNLABELLED The purpose of this explorative study is to determine if critically ill patients experience cardiac atrophy that can be quantified as a loss of left ventricular mass (LVM) and thus detected by echocardiography. DESIGN Retrospective single-center cohort study. SETTING Patients admitted to a tertiary medical center in Boston, MA. PATIENTS Adult critically ill patients with ICU length of stay greater than or equal to 5 days. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We conducted a retrospective cohort study of 68 patients, of which 42 were included in the final analysis (mean age 60.9 ± 19.2 yr; 47.6% male). The median length of ICU stay was 11.3 days (interquartile range, 6.8-20.1 d). A decrease in mean LVM over the course of admission for critical illness was observed (median 189.11 g [162.82-240.20 g] vs 176.69 g [142.37-226.26 g]; p = 0.01). After adjusting for sex, age, fluid balance, ICU type, dietary orders, time between echocardiograms, and vasopressor use, this decrease in LVM remained consistent (mean difference, -21.30 g; 95% CI, -41.85 to -0.74; p = 0.04). Relative wall thickness (RWT) did not change during admission. CONCLUSIONS These data reveal that a loss of LVM is present in patients over their ICU stay without a corresponding change in RWT, consistent with cardiac atrophy. Future prospective studies are needed to confirm these findings and identify possible sequelae of this finding.
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Santangelo G, Bursi F, Toriello F, Tamagni ME, Fior G, Massironi L, Bertelli S, Fanin A, Gambini O, Carugo S, Benetti A. Echocardiographic changes in anorexia nervosa: a pathophysiological adaptation or a disease? Intern Emerg Med 2022; 17:777-787. [PMID: 34677790 DOI: 10.1007/s11739-021-02871-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022]
Abstract
Anorexia Nervosa is one of the most common form of eating disorders. Cardiac involvement occurs in approximately 80% of patients. Few reports focused on the association between body weight fluctuations and echocardiographic abnormalities, considering linear measurements. We describe echocardiographic and clinical features among male and female patients with anorexia nervosa and the effect of weight gain on these parameters. We performed a single center, retrospective study of patients followed at a dedicated multidisciplinary Unit. The study population consisted of 81 patients, mean age 25 ± 11 years, 94% female. Median body mass index was 14.4 kg/m2 (25th-75th percentile 12.7-15.6 kg/m2). Patients with body mass index below the median value had more often pericardial effusion, smaller left ventricular mass and left ventricular end-diastolic volume and thinner interventricular septum. However, when indexed to body surface area, left ventricular mass and volumes were within the normal range in 90% of population. Patients with pericardial effusion showed mitral valve abnormalities and lower values of white blood cells and platelets, although within normal limits. Presence of pericardial effusion was not related to inflammatory parameters or low plasma protein levels. In 39 patients who displayed weight gain during a median follow-up of 189 days (25th-75th percentile 47-471), increased left ventricular mass, interventricular septum thickness, white blood cells and platelet count and decreased pericardial effusion were observed. Patients with anorexia nervosa have a specific echocardiographic pattern which seems to be proportional to the body size, suggesting a pathophysiological adaptation to the lack of substrates.
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Affiliation(s)
- G Santangelo
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy.
| | - F Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - F Toriello
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - M E Tamagni
- Division of Internal Medicine, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - G Fior
- Division of Psychiatry, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - L Massironi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - S Bertelli
- Division of Psychiatry, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - A Fanin
- Division of Internal Medicine, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - O Gambini
- Division of Psychiatry, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - S Carugo
- Division of Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - A Benetti
- Division of Internal Medicine, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
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Paysal J, Thireau J, Terral D, Rochette E, Obert P, Merlin E, Nottin S. Cardiac Remodeling and Its Determinants in Anorexia Nervosa Adolescents: Impact of Weight Recovery. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040458. [PMID: 35455501 PMCID: PMC9031014 DOI: 10.3390/children9040458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022]
Abstract
Cardiovascular alterations in anorexia nervosa (AN) adolescents include bradycardia and decreased systolic blood pressure and left ventricular mass. However, their determinants remain poorly understood. We assessed the associations between morphological and functional left ventricular (LV) remodeling, autonomic control by heart rate variability (HRV) analysis, thyroid hormones and brain natriuretic peptide (BNP) levels in AN female adolescents without or with weight recovery (WR). Fifty-nine female adolescents including 16 AN patients without WR (mean age 13.9 years (10−16)), 10 AN patients with WR (15.7 years (12−18)) and 33 controls (14.1 years (10−18)) underwent night heart rate (HR) recording to measure HRV (and especially SD1/SD2, the ratio between instantaneous (SD1) and long-term (SD2) standard deviation of R-R intervals, reflecting sympatho-vagal balance), speckle tracking echocardiography to assess LV global longitudinal strain (GLS) and blood test for dosage of tri-iodothyronine (T3) hormone and NT-proBNP. Compared to controls, AN patients without WR presented with lower HR (55 ± 7 vs. 68 ± 6 bpm; p < 0.001), parasympathetic hyperactivity, and higher GLS (−19.2 ± 1.8 vs. −16.9 ± 2.8%; p = 0.009). These alterations were partly abolished in AN patients with WR. In a multivariate regression analysis, T3 was the main factor explaining the variance of SD1/SD2, a sympatho-vagal balance marker. NT-proBNP levels were not correlated with cardiac alterations. AN patients had parasympathetic hyperactivity linked with their rate of T3, and a higher GLS. These alterations were partly restored in AN patients with WR.
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Affiliation(s)
- Justine Paysal
- LAPEC UPR 4278, Avignon University, 84000 Avignon, France; (J.P.); (P.O.)
- Néonatologie et Réanimation Pédiatrique, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Jérôme Thireau
- CNRS, INSERM, PhyMedExp, University of Montpellier, 34000 Montpellier, France;
| | - Daniel Terral
- Pédiatrie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (D.T.); (E.R.); (E.M.)
| | - Emmanuelle Rochette
- Pédiatrie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (D.T.); (E.R.); (E.M.)
- INSERM, CIC 1405, Unité CRECHE, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Philippe Obert
- LAPEC UPR 4278, Avignon University, 84000 Avignon, France; (J.P.); (P.O.)
| | - Etienne Merlin
- Pédiatrie, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France; (D.T.); (E.R.); (E.M.)
- INSERM, CIC 1405, Unité CRECHE, Université Clermont Auvergne, 63000 Clermont-Ferrand, France
| | - Stéphane Nottin
- LAPEC UPR 4278, Avignon University, 84000 Avignon, France; (J.P.); (P.O.)
- Correspondence: ; Tel.: +334-901-629-31
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Cardiac abnormalities determined by tissue Doppler imaging and arrhythmias in adolescents with anorexia nervosa. Cardiol Young 2022; 32:266-269. [PMID: 34092268 DOI: 10.1017/s1047951121001852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Anorexia nervosa has a prevalence of 0.5-3% in adolescents, placing this population at increased risk of cardiac anomalies including arrhythmias, pericardial effusion, and myocardial dysfunction. Our objective is to describe cardiovascular anomalies observed by tissue Doppler imaging in patients with anorexia nervosa. METHODS We retrospectively reviewed electrocardiogram, Holter, and echocardiography findings in 28 patients diagnosed with anorexia nervosa. RESULTS Electrocardiogram was abnormal in 71% of patients with sinus bradycardia observed in 57%. Holter confirmed sinus bradycardia without significant pauses. Prolonged QTc, low voltage, and ectopic beats were each seen in 14% of patients. Wenckebach atrioventricular block was observed in one patient. Supraventricular or ventricular tachycardia was not observed. Echocardiography showed structurally normal heart in all patients. Pericardial effusion was seen in 7.1% of patients and left ventricular mass was decreased in 10.7%. Mean ejection fraction was 0.73 and mean fractional shortening was 38.4%. Tissue Doppler imaging revealed systolic or diastolic dysfunction in four patients with e', a', and s' velocities in the lateral and septal basal segments more than two standard deviations below the mean. Two patients had decreased left ventricular mass but no significant difference in disease duration from the group. Basal segment velocities below one standard deviation were also observed in an additional seven patients. CONCLUSION A trend for decreased tissue Doppler imaging velocities was seen in 25.0% of patients, while significant systolic and diastolic dysfunction was seen in 14.3% of patients, associated with a significant reduction in left ventricular mass and independent of disease duration.
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Smythe J, Colebourn C, Prisco L, Petrinic T, Leeson P. Cardiac abnormalities identified with echocardiography in anorexia nervosa: systematic review and meta-analysis. Br J Psychiatry 2021; 219:477-486. [PMID: 32026793 DOI: 10.1192/bjp.2020.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Anorexia nervosa affects most organ systems, with 80% suffering from cardiovascular complications. AIMS To define echocardiographic abnormalities in anorexia nervosa through systematic review and meta-analysis. METHOD Two reviewers independently assessed eligibility of publications from Medline, EMBASE and Cochrane Database of Systematic Reviews registries. Studies were included if anorexia nervosa was the primary eating disorder and the main clinical association in described cardiac abnormalities. Data was extracted in duplicate and quality-assessed with a modified Newcastle-Ottawa scale. For continuous outcomes we calculated mean and standardised mean difference (SMD), and corresponding 95% confidence interval. For dichotomous outcomes we calculated proportion and corresponding 95% confidence interval. For qualitative data we summarised the studies. RESULTS We identified 23 eligible studies totalling 960 patients, with a mean age of 17 years and mean body mass index of 15.2 kg/m2. Fourteen studies (469 participants) reported data suitable for meta-analysis. Cardiac abnormalities seen in anorexia nervosa compared with healthy controls were reduced left ventricular mass (SMD 1.82, 95% CI 1.32-2.31, P < 0.001), reduced cardiac output (SMD 1.92, 95% CI 1.38-2.45, P < 0.001), increased E/A ratio (SMD -1.10, 95% CI -1.67 to -0.54, P < 0.001), and increased incidence of pericardial effusions (25% of patients, P < 0.01, 95% CI 17-34%, I2 = 80%). Trends toward improvement were seen with weight restoration. CONCLUSIONS Patients with anorexia nervosa have structural and functional cardiac changes, identifiable with echocardiography. Further work should determine whether echocardiography can help stratify severity and guide safe patient location, management and effectiveness of nutritional rehabilitation.
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Affiliation(s)
- Jodie Smythe
- Consultant Intensivist and Anaesthetist, Intensive Care Unit, Royal Berkshire NHS Foundation Trust, UK
| | - Claire Colebourn
- Consultant Medical Intensivist, Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Lara Prisco
- Consultant Intensivist and Anaesthetist and Senior Clinical Research Fellow, Neuroanaesthesia and Neurointensive Care, Oxford University Hospitals NHS Foundation Trust; and Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Tatjana Petrinic
- Outreach Librarian, Bodleian Healthcare Libraries, University of Oxford, Oxford University Hospitals NHS Foundation Trust, UK
| | - Paul Leeson
- Professor of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford University Hospitals NHS Foundation Trust, UK
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Abstract
Anorexia nervosa, one of the more frequent and severe eating disorders, is a chronic psychiatric disease with potentially serious somatic consequences. This behavioral symptomatology leads to weight loss, undernutrition, and more or less severe-potentially life-threatening-somatic complications including respiratory, hepatic, digestive and cardiac features, electrolyte disturbances, endocrine and bone impairment, immunodepression, and related opportunistic infections. In this review, the authors report an overview of cardiac diseases in this disease.
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Affiliation(s)
- Abdallah Fayssoil
- Nutrition Unit, Raymond Poincaré Hospital, APHP, boulevard Raymond Poincaré, 92380, Garches, France. .,Service de neurologie, Institut de Myologie, boulevard de l'hôpital, 75013, Paris, France. .,Pitié Salpetrière Hospital, APHP, boulevard de l'hôpital, 75013, Paris, France.
| | - Jean Claude Melchior
- Nutrition Unit, Raymond Poincaré Hospital, APHP, boulevard Raymond Poincaré, 92380, Garches, France
| | - Mouna Hanachi
- Nutrition Unit, Raymond Poincaré Hospital, APHP, boulevard Raymond Poincaré, 92380, Garches, France
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8
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Jordan JH, Castellino SM, Meléndez GC, Klepin HD, Ellis LR, Lamar Z, Vasu S, Kitzman DW, Ntim WO, Brubaker PH, Reichek N, D'Agostino RB, Hundley WG. Left Ventricular Mass Change After Anthracycline Chemotherapy. Circ Heart Fail 2019; 11:e004560. [PMID: 29991488 DOI: 10.1161/circheartfailure.117.004560] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 05/04/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Myocardial atrophy and left ventricular (LV) mass reductions are associated with fatigue and exercise intolerance. The relationships between the receipt of anthracycline-based chemotherapy (Anth-bC) and changes in LV mass and heart failure (HF) symptomatology are unknown, as is their relationship to LV ejection fraction (LVEF), a widely used measurement performed in surveillance strategies designed to avert symptomatic HF associated with cancer treatment. METHODS AND RESULTS We performed blinded, serial assessments of body weight, LVEF and mass, LV-arterial coupling, aortic stiffness, and Minnesota Living with Heart Failure Questionnaire measures before and 6 months after initiating Anth-bC (n=61) and non-Anth-bC (n=15), and in 24 cancer-free controls using paired t and χ2 tests and multivariable linear models. Participants averaged 51±12 years, and 70% were women. Cancer diagnoses included breast cancer (53%), hematologic malignancy (42%), and soft tissue sarcoma (5%). We observed a 5% decline in both LVEF (P<0.0001) and LV mass (P=0.03) in the setting of increased aortic stiffness and disrupted ventricular-arterial coupling in those receiving Anth-bC but not other groups (P=0.11-0.92). A worsening of the Minnesota Living with Heart Failure Questionnaire score in Anth-bC recipients was associated with myocardial mass declines (r=-0.27; P<0.01) but not with LVEF declines (r=0.11; P=0.45). Moreover, this finding was independent of LVEF changes and body weight. CONCLUSIONS Early after Anth-bC, LV mass reductions associate with worsening HF symptomatology independent of LVEF. These data suggest an alternative mechanism whereby anthracyclines may contribute to HF symptomatology and raise the possibility that surveillance strategies during Anth-bC should also assess LV mass.
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Affiliation(s)
- Jennifer H Jordan
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | | | - Giselle C Meléndez
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.).,Department of Internal Medicine, Section on Comparative Medicine, Department of Pathology (G.C.M.)
| | | | | | | | - Sujethra Vasu
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | - Dalane W Kitzman
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | - William O Ntim
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | - Peter H Brubaker
- Wake Forest School of Medicine, and Department of Health and Exercise Sciences (P.H.B)
| | - Nathaniel Reichek
- Wake Forest University, Winston-Salem, NC. Research and Education, The Heart Center, St Francis Hospital, Roslyn, NY (N.R.)
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Division of Public Health Sciences (R.B.D'A.)
| | - W Gregory Hundley
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.) .,Department of Radiological Sciences (W.G.H.)
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Anorexia nervosa and heart disease: a systematic review. Eat Weight Disord 2019; 24:199-207. [PMID: 30173377 DOI: 10.1007/s40519-018-0567-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/17/2018] [Indexed: 01/12/2023] Open
Abstract
Anorexia nervosa (AN) is an eating disorder that most frequently afflicts females in adolescence. In these subjects, cardiovascular complications are the main cause of morbidity and mortality. Aim of this review is to analyze the hemodynamic, pro-arrhythmic and structural changes occurring during all phases of this illness, including re-feeding. A systematic literature search was performed on studies in the MEDLINE database, from its inception until September 2017, with PUBMED interface focusing on AN and cardiovascular disease. This review demonstrated that the most common cardiac abnormalities in AN are bradycardia and QT interval prolongation, which may occasionally degenerate into ventricular arrhythmias such as Torsades des Pointes or ventricular fibrillation. As these arrhythmias may be the substrate of sudden cardiac death (SCD), they require cardiac monitoring in hospital. In addition, reduced cardiac mass, with smaller volumes and decreased cardiac output, may be found. Furthermore, mitral prolapse and a mild pericardial effusion may occur, the latter due to protein deficiency and low levels of thyroid hormone. In anorectic patients, some cases of hypercholesterolemia may be present; however, conclusive evidence that AN is an atherogenic condition is still lacking, although a few cases of myocardial infarction have been reported. Finally, refeeding syndrome (RFS), which occurs during the first days of refeeding, may engender a critically increased risk of acute, life-threatening cardiac complications.
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Escudero CA, Potts JE, Lam PY, De Souza AM, Duff K, Mugford GJ, Sandor GGS. Echocardiographic Assessment of Ventricular Function During Exercise in Adolescent Female Patients With Anorexia Nervosa. J Am Soc Echocardiogr 2019; 32:394-403.e3. [PMID: 30638724 DOI: 10.1016/j.echo.2018.10.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients with anorexia nervosa (AN) have altered physiologic responses to exercise. The aim of this study was to investigate exercise capacity and ventricular function during exercise in adolescent patients with AN. METHODS Sixty-six adolescent female patients with AN and 21 adolescent female control subjects who exercised to volitional fatigue on a semisupine ergometer, using an incremental step protocol of 20 W every 3 min, were retrospectively studied. Heart rate, blood pressure, and echocardiographic Doppler indices were measured at rest and during each stage of exercise. Fractional shortening, rate-corrected mean velocity of circumferential fiber shortening, stress at peak systole, cardiac output, and cardiac index were calculated. Minute ventilation, oxygen consumption, carbon dioxide production, and respiratory exchange ratio were measured using open-circuit spirometry. RESULTS Patients with AN had significantly lower body mass index (16.7 vs 19.7 kg/m2, P < .001), total work (1,126 vs 1,914 J/kg, P < .001), and test duration (13.8 vs 20.8 min, P < .001) compared with control subjects. Peak minute ventilation, oxygen consumption, and carbon dioxide production were significantly decreased in patients with AN. Heart rate, systolic blood pressure, cardiac index, fractional shortening, and rate-corrected mean velocity of circumferential fiber shortening demonstrated similar patterns of increase with progressive exercise between groups but were decreased at peak exercise in patients with AN. Body mass index percentile, age, peak oxygen consumption, and peak cardiac output were independently associated with exercise duration. CONCLUSIONS Adolescent patients with AN have reduced exercise capacity and peak cardiovascular indices compared with control subjects but normal patterns of cardiovascular response during progressive exercise. Systolic ventricular function is maintained during exercise in adolescents with AN.
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Affiliation(s)
- Carolina A Escudero
- Children's Heart Centre, British Columbia Children's Hospital, Canada; Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - James E Potts
- Children's Heart Centre, British Columbia Children's Hospital, Canada
| | - Pei-Yoong Lam
- Division of Adolescent Medicine, British Columbia Children's Hospital and Provincial Specialized Eating Disorders Program, Vancouver, Canada
| | - Astrid M De Souza
- Children's Heart Centre, British Columbia Children's Hospital, Canada
| | - Kathryn Duff
- Sports Science Program, Douglas College, New Westminster, British Columbia, Canada
| | - Gerald J Mugford
- Faculty of Medicine and Discipline of Psychiatry, Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | - George G S Sandor
- Children's Heart Centre, British Columbia Children's Hospital, Canada.
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11
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Excessive physical activity in young girls with restrictive-type anorexia nervosa: its role on cardiac structure and performance. Eat Weight Disord 2018; 23:653-663. [PMID: 29058271 DOI: 10.1007/s40519-017-0447-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 09/25/2017] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the influence of hyperactivity on left ventricular mass (LVM) in Anorexia Nervosa restricting-type (AN-R) and the correlation between LVM and auxologic parameters/circulating hormones. METHODS Echocardiography was performed in 44 AN-R girls, subgrouped in 24 hyperactive (ANH+) and 20 non-hyperactive (ANH-), and in 20 controls (HC). LVM indexed to Body Surface Area (LVMi) and LVM indexed to height (LVMh) were calculated. RESULTS LVMi and LVMh were significantly lower in the AN-R subjects compared to HC. Moreover, both LVMi and LVMh were higher in the ANH+ than in the ANH-. In the HC, LVMi was higher when compared to the ANH- subjects than to the ANH+. Stepwise analysis revealed that in the ANH+ group, fT4 was the only independent predictor of LVMh, while in the ANH- group, height was the only independent predictors of LVMi. CONCLUSIONS Despite its negative influence on disease severity and outcome, hyperactivity from the standpoint of cardiac function makes the LVM of AN-R young girls more similar to HC. LEVEL OF EVIDENCE Level III, case-control study.
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Escudero CA, Potts JE, Lam PY, De Souza AM, Mugford GJ, Sandor GGS. Doppler Echocardiography Assessment of Aortic Stiffness in Female Adolescents with Anorexia Nervosa. J Am Soc Echocardiogr 2018; 31:784-790. [PMID: 29559196 DOI: 10.1016/j.echo.2018.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is associated with abnormalities in biomarkers of cardiovascular risk. Arterial stiffness, as measured by pulse-wave velocity (PWV), is also a risk factor for cardiovascular disease. The aims of this study were to determine the stiffness of the aorta in female adolescents with AN and to determine if either the severity or the type of AN was associated with PWV. METHODS This was a retrospective case-control study. Adolescent patients with a clinical diagnosis of AN were included. Aortic diameter and pulse-wave transit time over a portion of the thoracic aorta were measured using Doppler echocardiography, and PWV was calculated. RESULTS There were 94 female patients with AN and 60 adolescent female control subjects. There was no significant difference in age between patients with AN and control subjects (15.5 ± 1.7 vs 15.1 ± 2.6 years, P = .220). Body mass index (16.0 ± 2.4 vs 19.7 ± 2.7 kg/m2, P < .001) and body mass index percentile (9.4 ± 15.6 vs 45.5 ± 26.2, P < .001) were significantly lower for patients with AN than control subjects. PWV (443 ± 106 vs 383 ± 77 cm/sec, P < .001) was significantly higher in patients with AN than control subjects. Similar differences from control subjects were found in patients with AN with both lower and higher body mass index percentiles and also in patients with AN with the restrictive or the binge-purge subtype. CONCLUSIONS Female adolescents with AN have increased aortic stiffness compared with control subjects. This study suggests that patients with AN may be at increased risk for future cardiovascular disease. Future studies are required to determine the reversibility of these changes with weight restoration.
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Affiliation(s)
- Carolina A Escudero
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - James E Potts
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Pei-Yoong Lam
- Division of Adolescent Medicine, British Columbia Children's Hospital and Provincial Specialized Eating Disorders Program, Vancouver, British Columbia, Canada
| | - Astrid M De Souza
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Gerald J Mugford
- Memorial University of Newfoundland, Faculty of Medicine and Discipline of Psychiatry, St. John's, Newfoundland, Canada
| | - George G S Sandor
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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Tsuruda T, Shinohara N, Ogata M, Kitamura K, Ochiai H. Transient Left Ventricular Contractile Dysfunction during the Treatment of Rhabdomyolysis: A Case Report and Literature Review. Intern Med 2017; 56:2797-2803. [PMID: 28924116 PMCID: PMC5675946 DOI: 10.2169/internalmedicine.8478-16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Transient left ventricular contractile dysfunction (TLVCD) is often observed as a result of stress-related cardiomyopathy; however, recent reports suggest that rhabdomyolysis and eating disorders can also induce the development of TLVCD. We report a 52-year-old malnourished man who developed acute heart failure on day 4 of treatment for rhabdomyolysis. Transthoracic echocardiogram revealed severe hypokinesis at the apical and mid-ventricular segments, except for the basal segments of the left ventricular wall, which recovered within one week. We discuss the pathogenesis of TLVCD with sympathetic nerve activation in association with rhabdomyolysis or refeeding syndrome.
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Affiliation(s)
- Toshihiro Tsuruda
- Department of Internal Medicine, Circulatory and Body Fluid Regulation, University of Miyazaki, Japan
| | | | - Miyuki Ogata
- Clinical Laboratory, Faculty of Medicine, University of Miyazaki, Japan
| | - Kazuo Kitamura
- Department of Internal Medicine, Circulatory and Body Fluid Regulation, University of Miyazaki, Japan
| | - Hidenobu Ochiai
- Trauma & Critical Care Center, University of Miyazaki, Japan
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14
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Sardar MR, Greway A, DeAngelis M, Tysko EO, Lehmann S, Wohlstetter M, Patel R. Cardiovascular Impact of Eating Disorders in Adults: A Single Center Experience and Literature Review. Heart Views 2016; 16:88-92. [PMID: 27326349 PMCID: PMC4590190 DOI: 10.4103/1995-705x.164463] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Eating disorders have multiple medical sequelae, including potentially life-threatening cardiovascular complications. This article describes our cardiology practice experience of treating adults with eating disorders in the outpatient setting and documents baseline cardiac findings in this complex patient population. We describe our findings in patients across the spectrum of eating disorders; past studies have generally focused on anorexia only. This article also includes a review of the current literature on cardiovascular complications associated with disordered eating.
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Affiliation(s)
| | - Andrea Greway
- Lankenau Heart Institute, Cooper University Hospital, New Jersey, USA
| | - Michael DeAngelis
- Lankenau Heart Institute, Cooper University Hospital, New Jersey, USA
| | | | - Shawn Lehmann
- Renfrew Center, Cooper University Hospital, New Jersey, USA
| | | | - Riti Patel
- Lankenau Heart Institute, Cooper University Hospital, New Jersey, USA
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15
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Abstract
UNLABELLED Introduction Anorexia nervosa is an eating disorder, which is associated with many different medical complications as a result of the weight loss and malnutrition that characterise this illness. It has the highest mortality rate of any psychiatric disorder. A large portion of deaths are attributable to the cardiac abnormalities that ensue as a result of the malnutrition associated with anorexia nervosa. In this review, the cardiac complications of anorexia nervosa will be discussed. METHODS A comprehensive literature review on cardiac changes in anorexia nervosa was carried out. RESULTS There are structural, functional, and rhythm-type changes that occur in patients with anorexia nervosa. These become progressively significant as ongoing weight loss occurs. CONCLUSION Cardiac changes are inherent to anorexia nervosa and they become more life-threatening and serious as the anorexia nervosa becomes increasingly severe. Weight restoration and attention to these cardiac changes are crucial for a successful treatment outcome.
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16
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Escudero CA, Potts JE, Lam PY, De Souza AM, Mugford GJ, Sandor GGS. An Echocardiographic Study of Left Ventricular Size and Cardiac Function in Adolescent Females with Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2015; 24:26-33. [DOI: 10.1002/erv.2409] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 08/28/2015] [Accepted: 08/31/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | - James E. Potts
- Children's Heart Centre; British Columbia Children's Hospital; Canada
| | - Pei-Yoong Lam
- Division of Adolescent Medicine and Provincial Specialized Eating Disorders Program; British Columbia Children's Hospital; Canada
| | | | - Gerald J. Mugford
- Faculty of Medicine and Discipline of Psychiatry; Memorial University of Newfoundland; Canada
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17
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Di Cola G, Jacoangeli F, Jacoangeli F, Lombardo M, Iellamo F. Cardiovascular disorders in anorexia nervosa and potential therapeutic targets. Intern Emerg Med 2014; 9:717-21. [PMID: 25056404 DOI: 10.1007/s11739-014-1107-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/05/2014] [Indexed: 10/25/2022]
Abstract
Anorexia nervosa (AN) is an eating disorder in which a distorted self-perception of body image and an excessive fear of gaining weight result in extreme restrictions in eating habits. AN may be divided into two types: a "binge-eating/purging type" during which the individual regularly engages in overeating and then purging behavior, and a "restricting type", in which she does not. AN is a serious medical problem in young people in Western societies. It is widely reported that patients with AN exhibit an enhanced mortality rate as compared with age-matched healthy subjects, which has been mainly ascribed to cardiac complications. At least one-third of all deaths in patients with anorexia nervosa are estimated to be due to cardiac causes, mainly sudden death. Cardiovascular complications of AN can be present in up to 80% of cases, and among them alterations in cardiac electrical activity, structure and hemodynamics have been reported as causes of morbidity and mortality. The objective of this brief review is to summarize current knowledge on the main cardiovascular complications of AN, their underlying mechanisms and the possible therapeutic approaches.
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Affiliation(s)
- Giovanni Di Cola
- Dipartimento di Medicina dei Sistemi, Università di Roma Tor Vergata, Via O. Raimondo, 8, 00173, Rome, Italy
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18
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Abstract
Eating disorders are usually associated with an increased risk of premature death with a wide range of rates and causes of mortality. “Sudden death” has been defined as the abrupt and unexpected occurrence of fatality for which no satisfactory explanation of the cause can be ascertained. In many cases of sudden death, autopsies do not clarify the main cause. Cardiovascular complications are usually involved in these deaths. The purpose of this review was to report an update of the existing literature data on the main findings with respect to sudden death in eating disorders by means of a search conducted in PubMed. The most relevant conclusion of this review seems to be that the main causes of sudden death in eating disorders are those related to cardiovascular complications. The predictive value of the increased QT interval dispersion as a marker of sudden acute ventricular arrhythmia and death has been demonstrated. Eating disorder patients with severe cardiovascular symptoms should be hospitalized. In general, with respect to sudden death in eating disorders, some findings (eg, long-term eating disorders, chronic hypokalemia, chronically low plasma albumin, and QT intervals >600 milliseconds) must be taken into account, and it must be highlighted that during refeeding, the adverse effects of hypophosphatemia include cardiac failure. Monitoring vital signs and performing electrocardiograms and serial measurements of plasma potassium are relevant during the treatment of eating disorder patients.
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Kastner S, Salbach-Andrae H, Renneberg B, Pfeiffer E, Lehmkuhl U, Schmitz L. Echocardiographic findings in adolescents with anorexia nervosa at beginning of treatment and after weight recovery. Eur Child Adolesc Psychiatry 2012; 21:15-21. [PMID: 22086424 DOI: 10.1007/s00787-011-0227-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 11/03/2011] [Indexed: 10/15/2022]
Abstract
Anorexia nervosa (AN) is an eating disorder with somatic complications. The aim of the study was to analyse echocardiographic abnormalities in patients with AN at initial examination and after weight restoration. A total of 173 consecutively admitted adolescents (aged 12-17 years), diagnosed with DSM-IV AN (307.1) were evaluated in a child and adolescent psychiatric department of a major university hospital from December 1997 to August 2008. In addition, 40 healthy adolescents of the same age with normal weight were examined. In patients with AN, 34.7% had a pericardial effusion (PE) which was clinically silent. In contrast, none of the controls presented with PE (p < 0.001). No differences across AN subtypes were observed. Patients with PE showed significantly lower body mass index (BMI) (p = 0.016) than patients without PE. They had more prominent low-T3 syndrome (p = 0.003) and longer duration of hospitalisation (p = 0.008) after controlling for BMI at admission. Remission of PE was observed in 88% of the patients after weight restoration. Left ventricular end-diastolic and end-systolic dimensions in AN were significantly lower than in controls (p < 0.001). There were no differences in interventricular septum thickness, posterior wall thickness and fractional shortening. This report indicates that adolescents with AN show cardiac abnormalities in comparison to healthy young women. Furthermore, PE is a frequent cardiac complication in patients with AN and it is associated with BMI, low T3 serum levels and duration of hospitalisation.
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Affiliation(s)
- Sabrina Kastner
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Germany.
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20
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Carlomagno G, Mercurio V, Ruvolo A, Senatore I, Halinskaya I, Fazio V, Affuso F, Fazio S. Endocrine alterations are the main determinants of cardiac remodelling in restrictive anorexia nervosa. ISRN ENDOCRINOLOGY 2011; 2011:171460. [PMID: 22363867 PMCID: PMC3262625 DOI: 10.5402/2011/171460] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 05/11/2011] [Indexed: 01/22/2023]
Abstract
Objective. Anorexia nervosa is a condition of reduced hemodynamic load, characterized by varying degrees of cardiac remodelling, only in part related to reduced body mass; the mechanism for such variability, as well as its clinical significance, remains unknown. Aim of the study was to assess the possible influence of a great number of clinical, biochemical, and endocrine factors on cardiovascular parameters in restrictive anorexia nervosa. Method. Twenty-five female patients hospitalized for restrictive anorexia nervosa underwent extensive cardiovascular, clinical, and biochemical evaluation. Results. Height-adjusted and cardiac workload-matched left ventricular mass was significantly related to several endocrine parameters, blood pressure, and vasoreactivity. On multivariate analysis, IGF/GH ratio and systolic blood pressure were the only independent predictors of height-adjusted ventricular mass (adj-R(2) = 0.585; P = 0.001); when matching for cardiac workload, left ventricular mass was independently predicted only by GH and FT3 levels. All effects were independent of patient's weight and BMI. Conclusions. Indices of endocrine impairment seem to be the most relevant determinants of left ventricular hypotrophy in anorectic patients, apparently independent of reduced hemodynamic load and BMI. In particular, IGF/GH ratio and FT3 seem to particularly affect left ventricular mass in this population.
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Affiliation(s)
- Guido Carlomagno
- Department of Internal Medicine, Cardiovascular and Immunological Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy
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21
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DiVasta AD, Walls CE, Feldman HA, Quach AE, Woods ER, Gordon CM, Alexander ME. Malnutrition and hemodynamic status in adolescents hospitalized for anorexia nervosa. ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE 2010; 164:706-13. [PMID: 20679161 PMCID: PMC3205985 DOI: 10.1001/archpediatrics.2010.138] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To determine the effects of malnutrition on hemodynamic status of adolescents hospitalized for anorexia nervosa. DESIGN Longitudinal observational study. SETTING Tertiary care pediatric hospital. Patients Thirty-eight adolescents with anorexia nervosa, aged 13 to 21 years, with a mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) of 15.9 (1.8). Intervention Subjects received standard care, including bed rest and graded nutritional therapy. A subsample of subjects (n=19) returned 11 to 57 weeks following hospitalization for a second cardiac evaluation. MAIN OUTCOME MEASURES Results from a 15-lead electrocardiogram, echocardiogram, treadmill stress test, and spinal bone mineral density measurement. RESULTS On admission, 26 subjects (68%) had sinus bradycardia. Bradycardia was less common in participants with a longer duration of illness (P=.04). Left ventricle mass was lower than predicted for age (Z score<-1.0) in 11 subjects (31%). Exercise tolerance was normal by all measures. Both heart rate and QT interval were predictors of spinal bone mineral density. In those who returned for follow-up, absolute measures of left ventricle mass did not change (P=.27). However, the corresponding Z scores declined over time (mean [SD] change, -0.9 [1.3]; P=.02). CONCLUSIONS In acutely malnourished adolescents with anorexia nervosa, few truly pathologic cardiac findings were identified. Sinus bradycardia was observed in most cases. Mild reductions in left ventricle mass and left ventricle function were seen both at baseline and at follow-up, suggesting early sparing of cardiac muscle in the face of moderate malnutrition as well as a relative delay of cardiac muscle restoration. The association of hemodynamic status with altered spinal bone mineral density emphasizes the range of systems affected by malnutrition in anorexia nervosa.
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Affiliation(s)
- Amy D DiVasta
- Department of Cardiology, Children's Hospital Boston, 333 Longwood Ave, Boston, MA 02115, USA.
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22
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Do malnutrition and fluoxetine neonatal treatment program alterations in heart morphology? Life Sci 2008; 82:1131-6. [DOI: 10.1016/j.lfs.2008.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Revised: 03/14/2008] [Accepted: 03/24/2008] [Indexed: 11/17/2022]
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23
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Cho YK, Yang SJ, Ma JS. Pericardial effusion in three cases of anorexia nervosa. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.2.209] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Young Kuk Cho
- Department of Pediatrics, Chonnam National University Medical School and Research Institute of Medical Sciences, Gwangju, Korea
| | - Su Jin Yang
- Department of Psychiatry, Chonnam National University Medical School and Research Institute of Medical Sciences, Gwangju, Korea
| | - Jae Sook Ma
- Department of Pediatrics, Chonnam National University Medical School and Research Institute of Medical Sciences, Gwangju, Korea
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24
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Murialdo G, Casu M, Falchero M, Brugnolo A, Patrone V, Cerro PF, Ameri P, Andraghetti G, Briatore L, Copello F, Cordera R, Rodriguez G, Ferro AM. Alterations in the autonomic control of heart rate variability in patients with anorexia or bulimia nervosa: correlations between sympathovagal activity, clinical features, and leptin levels. J Endocrinol Invest 2007; 30:356-62. [PMID: 17598965 DOI: 10.1007/bf03346310] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Changes in body composition, hormone secretions, and heart function with increased risk of sudden death occur in eating disorders. In this observational clinical study, we evaluated sympathovagal modulation of heart rate variability (HRV) and cardiovascular changes in response to lying-to-standing in patients with anorexia (AN) or bulimia nervosa (BN) to analyze: a) differences in autonomic activity between AN, BN, and healthy subjects; b) relationships between autonomic and cardiovascular parameters, clinical data and leptin levels in patients with eating disorders. HRV, assessed by power spectral analysis of R-R intervals, blood pressure (BP) and heart rate (HR) were studied by tilt-table test in 34 patients with AN, 16 with BN and 30 healthy controls. Autonomic and cardiovascular findings were correlated with clinical data, and serum leptin levels. Leptin levels were lowered in AN vs BN and healthy subjects (p<0.0001), but both AN and BN patients showed unbalanced sympathovagal control of HRV due to relative sympathetic failure, prevalent vagal activity, impaired sympathetic activation after tilting, independently from their actual body weight and leptin levels. No significant correlations were obtained between HRV data vs clinical data, BP and HR findings, and leptin levels in eating disorders. Body mass indices (BMI) (p<0.02), and leptin levels (p<0.04) correlated directly with BP values. Our data showed alterations of sympathovagal control of HRV in eating disorders. These changes were unrelated to body weight and BMI, diagnosis of AN or BN, and leptin levels despite the reported effects of leptin on the sympathetic activity.
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Affiliation(s)
- G Murialdo
- Department of Endocrine and Medical Sciences, University of Genoa, Genoa, Italy.
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Olivares JL, Vázquez M, Fleta J, Moreno LA, Pérez-González JM, Bueno M. Cardiac findings in adolescents with anorexia nervosa at diagnosis and after weight restoration. Eur J Pediatr 2005; 164:383-6. [PMID: 15909184 DOI: 10.1007/s00431-005-1647-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Accepted: 01/18/2005] [Indexed: 10/25/2022]
Abstract
UNLABELLED The aim of this study was to compare heart abnormalities in a group of young women with anorexia nervosa at diagnosis and after weight restoration. A total of 40 young women with anorexia nervosa were evaluated, at baseline, (diagnosis) and follow-up (9 to 18 months later) and matched with 40 healthy women of the same age and of normal weight. QT interval was measured from surface electrocardiograms. QT dispersion was defined as the difference between maximum QT and minimum QT occurring in any of the 12 leads. Left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular mass, left ventricular mass index, cardiac output, fractional shortening and fractional ejection, were measured by echocardiography. In anorexia nervosa patients, corrected QT interval and QT dispersion, significantly decreased from baseline to follow-up. Left ventricular end-diastolic dimension, left ventricular mass index, and cardiac output, in anorexia nervosa were significantly lower at diagnosis than at follow-up after weight restoration. CONCLUSION Adolescents with anorexia nervosa have significant functional and structural cardiac abnormalities; weight gain was associated with improvement. Appropriate attention should be paid to cardiac involvement.
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Affiliation(s)
- José L Olivares
- Department of Paediatrics, "Lozano Blesa" Hospital, University of Zaragoza School of Medicine, C/ Domingo Miral s/n, 50009, Zaragoza, Spain.
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26
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Galetta F, Franzoni F, Cupisti A, Morelli E, Santoro G, Pentimone F. Early detection of cardiac dysfunction in patients with anorexia nervosa by tissue Doppler imaging. Int J Cardiol 2005; 101:33-7. [PMID: 15860380 DOI: 10.1016/j.ijcard.2004.03.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2003] [Revised: 02/19/2004] [Accepted: 03/01/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cardiac damage is a major complication of chronic starvation. The aim of this study was to evaluate the changes of left ventricular function in patients with anorexia nervosa by means of pulsed tissue Doppler imaging. METHODS A total of 20 females (age 22.4+/-4.3 years) with overt anorexia nervosa, 20 matched healthy thin females with body mass index < 19 kg/m2 and 20 matched healthy normal-weight females underwent both standard echocardiography and tissue Doppler imaging. Myocardial systolic wave (Sm) and early (Em) and atrial (Am) diastolic waves were measured on the basal lateral segment and the basal interventricular septum from the apical four-chamber view. RESULTS When compared with control groups, the anorexia nervosa group showed lower left ventricular mass (p < 0.0001), lower Sm peak of both lateral wall (6.5+/-0.9 vs. 9.4+/-2.1 and vs. 9.5+/-1.9 cm/sec, p < 0.001) and septum (5.6+/-1.5 vs. 8.6+/-1.6 and vs. 8.8+/-1.5 cm/sec, p < 0.001), and comparable Em, Am and Em/Am ratio. The ratio between transmitral peak E and Em was significantly greater in anorexic patients than in controls (lateral wall: 8.1+/-0.1 vs. 6.8+/-0.2 and vs. 6.9+/-0.2, p < 0.001; septum: 10.8+/-0.4 vs. 8.8+/-0.5 and vs. 8.8+/-0.3, p < 0.001). No differences were observed between thin and normal-weight females. In the anorexia nervosa group, S(m) peak was significantly related to left ventricular mass indexed, at both septum (r = 0.55, p < 0.02) and lateral wall (r = 0.49, p < 0.03) levels. CONCLUSIONS These results show that anorexia nervosa is associated with left ventricular systolic dysfunction, which is related with the reduction of cardiac mass. Tissue Doppler imaging can give useful information in the identification of regional left ventricular dysfunction, in addition to traditional parameters.
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Affiliation(s)
- Fabio Galetta
- Department of Internal Medicine, School of Medicine, University of Pisa, Via Roma 67, Pisa 56100, Italy.
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27
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Florea VG, Moon J, Pennell DJ, Doehner W, Coats AJS, Anker SD. Wasting of the left ventricle in patients with cardiac cachexia: a cardiovascular magnetic resonance study. Int J Cardiol 2004; 97:15-20. [PMID: 15336800 DOI: 10.1016/j.ijcard.2003.05.050] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2003] [Accepted: 05/25/2003] [Indexed: 11/27/2022]
Abstract
BACKGROUND The "cachectic heart" has been described as a pathologic decrease in the size and mass of the heart, but no in vivo studies have shown changes in cardiac dimensions or left ventricular (LV) mass over time in chronic heart failure (CHF) associated with body wasting (cardiac cachexia). Cardiovascular magnetic resonance (CMR) has high reproducibility and is more sensitive than other techniques. METHODS CMR studies of LV volumes and mass were performed at baseline and a mean of 15 months later in nine CHF patients with cardiac cachexia and 28 matched CHF controls without cachexia (mass index 23 +/- 1 vs. 29 +/- 5 kg/m2, P=0.0005). RESULTS At baseline, LV end-diastolic volume (197 +/- 78 vs. 203 +/- 65 ml), end-systolic volume (131 +/- 75 vs. 126 +/- 63 ml), LV mass (213 +/- 44 vs. 222 +/- 62 g), and LV ejection fraction (38 +/- 19% vs. 40 +/- 16%) did not differ between cachectic patients and controls (all P>0.10). During follow-up, there was a significant decrease in LV mass in patients with cachexia (-16 g, P<0.05) and a trend to increase in LV mass in patients without cachexia (+7 g, P=0.12, comparison between groups: P=0.010). CONCLUSIONS The direction of changes over time in LV mass differs in CHF patients with cachexia as compared with non-cachectic controls. A significant decrease in LV mass occurs in patients with cardiac cachexia. This study documents in vivo the occurrence of wasting of the left ventricle in patients with CHF who demonstrate general body wasting.
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Affiliation(s)
- Viorel G Florea
- Department of Clinical Cardiology, Imperial College of Science, National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, UK
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28
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Roche F, Barthélémy JC, Garet M, Costes F, Pichot V, Duverney D, Kadem M, Millot L, Estour B. Chronotropic incompetence to exercise separates low body weight from established anorexia nervosa. Clin Physiol Funct Imaging 2004; 24:270-5. [PMID: 15383083 DOI: 10.1111/j.1475-097x.2004.00561.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Chronotropic incompetence (CI), characterized by an attenuated heart rate (HR) response to exercise could participate to the limitation of exercise capacity in anorexia nervosa (AN). Therefore, we evaluated the role of cardiac sympathetic responsiveness in AN patients. In addition, the ambulatory value of autonomic control using spectral analysis of heart rate variability (HRV) was determined and correlated to maximal exercise performance. Twenty-two patients hospitalized for weight loss and suspicion of AN were included in the study. All performed a symptom-limited exercise test with measurement of gas exchange for chronotropic response to exercise evaluation. Holter ECG recordings allowed daytime and night-time spectral domain HRV analysis in order to evaluate the alteration of sympathetic control of HR in free-living conditions. CI defined as a failure to achieve 80% of heart rate reserve (%HRR) was observed in 13 (59%) patients (CI+). This group presented a higher body mass deficit than the group without CI (CI-; -35.1 +/- 8.7% versus -26.1 +/- 10.7%; P<0.05). Obviously, patients with a lower body mass index (BMI < 16 kg m(-2), n = 14) revealed a more severe limitation to maximal exercise with a lower peak HR, a lower peak Vo(2), and a lower maximal O(2) pulse (P<0.05). BMI was significantly correlated to peak Vo(2), maximal HR, and %HRR achieved at peak exercise. Daytime HRV parameters reflecting the sympathetic autonomic equilibrium (LF nu, LF/HF ratio) were significantly lower in CI+ patients. Blunted sympathetic response to maximal exercise is frequent and correlated to weight deficit. The present data suggest a major autonomic derangement in AN characterized by a cardiac sympathetic withdrawal.
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Affiliation(s)
- Frédéric Roche
- Laboratoire de Physiologie-Groupe de Recherche PPEH, Groupe de Recherche SYNAPSE, Service d'Exploration Fonctionnelle CardioRespiratoire, CHU Nord, 42055 Saint-Etienne Cedex, France.
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Okoshi K, Fioretto JR, Okoshi MP, Cicogna AC, Aragon FF, Matsubara LS, Matsubara BB. Food restriction induces in vivo ventricular dysfunction in spontaneously hypertensive rats without impairment of in vitro myocardial contractility. Braz J Med Biol Res 2004; 37:607-13. [PMID: 15064825 DOI: 10.1590/s0100-879x2004000400019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiac structures, function, and myocardial contractility are affected by food restriction (FR). There are few experiments associating undernutrition with hypertension. The aim of the present study was to analyze the effects of FR on the cardiac response to hypertension in a genetic model of hypertension, the spontaneously hypertensive rat (SHR). Five-month-old SHR were fed a control or a calorie-restricted diet for 90 days. Global left ventricle (LV) systolic function was evaluated in vivo by transthoracic echocardiogram and myocardial contractility and diastolic function were assessed in vitro in an isovolumetrically beating isolated heart (Langendorff preparation). FR reduced LV systolic function (control (mean +/- SD): 58.9 +/- 8.2; FR: 50.8 +/- 4.8%, N = 14, P < 0.05). Myocardial contractility was preserved when assessed by the +dP/dt (control: 3493 +/- 379; FR: 3555 +/- 211 mmHg/s, P > 0.05), and developed pressure (in vitro) at diastolic pressure of zero (control: 152 +/- 16; FR: 149 +/- 15 mmHg, N = 9, P > 0.05) and 25 mmHg (control: 155 +/- 9; FR: 150 +/- 10 mmHg, N = 9, P > 0.05). FR also induced eccentric ventricular remodeling, and reduced myocardial elasticity (control: 10.9 +/- 1.6; FR: 9.2 +/- 0.9%, N = 9, P < 0.05) and LV compliance (control: 82.6 +/- 16.5; FR: 68.2 +/- 9.1%, N = 9, P < 0.05). We conclude that FR causes systolic ventricular dysfunction without in vitro change in myocardial contractility and diastolic dysfunction probably due to a reduction in myocardial elasticity.
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Affiliation(s)
- K Okoshi
- Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil
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Karagoz T, Ozer S, Bayrakci V, Ergun N. Echocardiographic evaluation of wheelchair-bound basketball players. Pediatr Int 2003; 45:414-20. [PMID: 12911477 DOI: 10.1046/j.1442-200x.2003.01752.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Cardiopulmonary function in sedentary men whose lower limbs have been immobilized for years has been shown to be markedly lower than normal. However, the cardiopulmonary function of paraplegics who regularly activate their upper limps and trunk has been suggested to be almost normal in a few studies. The purpose of the present study was to evaluate the left ventricular dimensions, left ventricular mass, systolic and diastolic function in adolescent wheelchair-bound basketball players using echocardio-graphy, and to compare the results with those of sedentary adolescents unable to use their lower extremities and the results of able bodied controls. METHODS The study group consisted of 22 male adolescent high school students who were unable to use their lower extremities: 11 were members of a high school basketball team who had been regularly playing basketball for at least 2 years, and 11 were sedentary adolescents none of whom was engaged in any kind of routine training program. The control group consisted of 11 healthy able-bodied male adolescents of similar age. RESULTS There were no significant differences in left ventricular dimensions and wall thickness, aortic root, left atrium diameters, or left ventricular filling characteristics between the three groups. Wheelchair-bound basketball players had increased left ventricular ejection fraction and shortening fraction compared with the sedentary unable-bodied individuals. Although left ventricular ejection fractions were significantly lower than in normal adolescents, all ejection fraction values except one were within the normal limits in the unable-bodied basketball players. CONCLUSION The results of the present study suggest that an upper extremity exercise program and sports such as basketball can improve the cardiac functions and additional echocardiographic functions of people unable to use their lower extremities, potentially to normal levels.
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Affiliation(s)
- Tevfik Karagoz
- Section of Cardiology, Department of Pediatrics, Hacettepe University Faculty of Medicine and Sport Physiotherapy Unit, Hacettepe University, Sihhiye, Ankara, Turkey.
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31
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Vázquez M, Olivares JL, Fleta J, Lacambra I, González M. [Cardiac disorders in young women with anorexia nervosa]. Rev Esp Cardiol 2003; 56:669-73. [PMID: 12855149 DOI: 10.1016/s0300-8932(03)76937-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION AND OBJECTIVES The objective of this study was to compare heart abnormalities in young women with anorexia nervosa and in a control group of the same age and sex. Patients and method. We report a matched case-control study of 30 adolescents with anorexia nervosa and 30 healthy women of the same age with normal weight. An electrocardiogram and echocardiogram were done. Heart parameters were measured on the electrocardiographic tracings, and QT dispersion was defined as the difference between maximum QT and minimum QT in any of the 12 leads. Diameter, mass and left ventricular mass index were measured. RESULTS QT and corrected QT intervals were significantly greater in patients with anorexia nervosa than in the control group. QT dispersion and corrected QT dispersion were significantly greater in anorexia nervosa than in the control group (QTd, 59.3 23.0 vs 38.4 8.0 ms; p = 0.000; QTcd, 56.5 24.2 vs. 40.3 21.8 ms; p = 0.011). Left ventricular mass was significantly lower in young women with anorexia nervosa. We found a significant relationship between body mass index and left ventricular mass index, and between the former and corrected QT dispersion. CONCLUSIONS Adolescents with anorexia nervosa show significant cardiac disorders in comparison to healthy women of the same age. This finding may be a useful indicator of the risk of arrhythmia and sudden death in patients with anorexia nervosa.
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Affiliation(s)
- Margarita Vázquez
- Departamento de Pediatría. Hospital Clínico Universitario Lozano Blesa. Zaragoza. España
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32
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Mont L, Castro J, Herreros B, Paré C, Azqueta M, Magriña J, Puig J, Toro J, Brugada J. Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery. J Am Acad Child Adolesc Psychiatry 2003; 42:808-13. [PMID: 12819440 DOI: 10.1097/01.chi.0000046867.56865.eb] [Citation(s) in RCA: 112] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Anorexia nervosa is a life-threatening condition, with significant risk for death due to cardiac complications. The objective of this study was to analyze the cardiac involvement in anorexia nervosa and to study the reversibility of cardiac abnormalities. METHOD Thirty-one consecutive adolescents (aged 12 to 17 years) with a diagnosis of anorexia nervosa were evaluated from January 1998 to January 1999 at the Hospital Clínic (University of Barcelona, Catalonia, Spain). An electrocardiogram, an echocardiogram, a 24-hour Holter recording with heart rate variability, an exercise test, and a tilt test were performed at initial examination and after refeeding (3 to 18 months later). RESULTS The basal body mass index was 15.2 +/- 2 kg/m2. Sinus bradycardia was found in 35% of patients, 93% showed a decreased left ventricular mass, and 70% had a diminished thickness of cardiac walls. The Holter recordings showed nocturnal bradycardia in 60% with an increased heart rate variability. After refeeding, a significant decrease in QT interval (p <.05) and QT dispersion (p <.01) was observed. Echocardiograms showed an increase in cardiac diameters (p <.01), left ventricular mass (p <.001), and cardiac output (p <.001). There was also an improvement in the exercise capacity (p <.05) and a normalization of the heart rate and heart rate variability (p <.05). CONCLUSION Cardiac structural and functional abnormalities provoked by anorexia nervosa are reversible in young adolescents after refeeding.
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Affiliation(s)
- Lluís Mont
- Institute of Cardiovascular Diseases, Hospital Clínic, University of Barcelona, Catalonia, Spain.
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33
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Galetta F, Franzoni F, Prattichizzo F, Rolla M, Santoro G, Pentimone F. Heart rate variability and left ventricular diastolic function in anorexia nervosa. J Adolesc Health 2003; 32:416-21. [PMID: 12782452 DOI: 10.1016/s1054-139x(03)00048-x] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the cardiac effects of starvation in a group of adolescents with anorexia nervosa (AN). METHODS Twenty-five patients with AN (range 13-20 years), compared with 25 age-matched thin and 25 age-matched control women with body mass index > 20 Kg/m(2), underwent a complete clinical evaluation, including echocardiogram and 24-hour electrocardiogram monitoring to evaluate heart rate variability (HRV) indices. RESULTS Compared to both thin and control women, patients with AN had greater HRV time domain indices (SDNN: 246.5 +/- 32.4 vs. 170.4 +/- 24 ms and vs. 181 +/- 21.2 ms, p <.001), and in the frequency domain a lower LF/HF ratio (4.2 +/- 1.3 vs. 6.7 +/- 1.2 and vs. 6.8 +/- 1.3 ms, p <.001). AN patients showed reduced left ventricular mass with normal systolic function and typical diastolic patterns, characterized by a lower peak velocity transmitral flow in late diastole (peak A: 35.9 +/- 8.5 vs. 45.2 +/- 7.3 cm/sec and vs. 46.6 +/- 6.3 cm/sec, p <.01), a comparable peak velocity in early diastole (peak E: 92.7 +/- 12.1 vs. 83 +/- 6.2 and vs. 86.8 +/- 9.1 cm/sec, ns) and, subsequently, a greater E/A ratio (2.8 +/- 0.7 vs. 1.8 +/- 0.3 and vs. 1.9 +/- .5, p <.01) than thinness and control groups. Moreover, SDNN was also positively related to E/A ratio (r =.54, p <.01). CONCLUSIONS Our findings demonstrate a cardiovascular vagal hyperactivity in AN, which appears to influence the ventricular diastolic dynamics. HRV and diastolic function analysis may represent useful tools in monitoring anorexia-induced cardiac modifications.
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Affiliation(s)
- Fabio Galetta
- Department of Internal Medicine, University of Pisa School of Medicien, Via Roma 67, 56126, Pisa, Italy.
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34
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Romano C, Chinali M, Pasanisi F, Greco R, Celentano A, Rocco A, Palmieri V, Signorini A, Contaldo F, de Simone G. Reduced hemodynamic load and cardiac hypotrophy in patients with anorexia nervosa. Am J Clin Nutr 2003; 77:308-12. [PMID: 12540387 DOI: 10.1093/ajcn/77.2.308] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Anorexia nervosa is associated with lower left ventricular mass (LVM) and systolic dysfunction. Whether these abnormalities reflect chronic protein-energy malnutrition or are primarily related to lower cardiac workload is unclear. OBJECTIVE The objective of the study was to verify whether low LVM in anorexia nervosa is explained by low hemodynamic load. DESIGN Ninety-one women with anorexia nervosa [macro x +/- SD age: 20.5 +/- 6.1 y; body mass index (in kg/m(2)): 15.6 +/- 1.9; group 1] and 62 normal-weight female control subjects (age: 22.5 +/- 5.5 y; body mass index: 20.9 +/- 1.2; group 2) underwent Doppler echocardiography. LVM was evaluated as the percentage predicted by body height, sex, and stroke work (systolic blood pressure x stroke volume). RESULTS The left ventricular chamber dimension was smaller and the chamber walls were thinner in group 1 than in group 2, which resulted in significantly lower LVM and LVM indexes (P < 0.0001). Ejection fraction, heart rate, stroke volume, and cardiac output were significantly (P < 0.007) lower in group 1, but peripheral resistance was substantially higher (P < 0.0001). The deviation of LVM from predicted values was lower and the proportion of subjects with inadequate LVM was significantly higher in group 1 than in group 2 (P < 0.0001). This difference was attenuated after adjustment for body weight and heart rate. There were no relations between LVM and laboratory tests in group 1. CONCLUSIONS Anorexia nervosa is a condition of low hemodynamic load that leads to low LVM. Even with adjustment for stroke work, however, LVM is lower than would be predicted by height, because of the effect of body weight reduction (ie, wasting of lean body mass).
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Affiliation(s)
- Carmela Romano
- Center for Obesity and Eating Disorders, Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples
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35
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Fioretto JR, Querioz SS, Padovani CR, Matsubara LS, Okoshi K, Matsubara BB. Ventricular remodeling and diastolic myocardial dysfunction in rats submitted to protein-calorie malnutrition. Am J Physiol Heart Circ Physiol 2002; 282:H1327-33. [PMID: 11893568 DOI: 10.1152/ajpheart.00431.2001] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The effects of protein-calorie malnutrition (PCM) on heart structure and function are not completely understood. We studied heart morphometric, functional, and biochemical characteristics in undernourished young Wistar rats. They were submitted to PCM from birth (undernourished group, UG). After 10 wk, left ventricle function was studied using a Langendorff preparation. The results were compared with age-matched rats fed ad libitum (control group, CG). The UG rats achieved 47% of the body weight and 44% of the left ventricular weight (LVW) of the CG. LVW-to-ventricular volume ratio was smaller and myocardial hydroxyproline concentration was higher in the UG. Left ventricular systolic function was not affected by the PCM protocol. The myocardial stiffness constant was greater in the UG, whereas the end-diastolic pressure-volume relationship was not altered. In conclusion, the heart is not spared from the adverse effects of PCM. There is a geometric alteration in the left ventricle with preserved ventricular compliance despite the increased passive myocardial stiffness. The systolic function is preserved.
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Affiliation(s)
- José R Fioretto
- Departments of Pediatrics, São Paulo State University, Botucatu Medical School, Botucatu 18.618 - 970, Brazil.
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36
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Galetta F, Franzoni F, Cupisti A, Belliti D, Prattichizzo F, Rolla M. QT interval dispersion in young women with anorexia nervosa. J Pediatr 2002; 140:456-60. [PMID: 12006961 DOI: 10.1067/mpd.2002.122726] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the degree of QT dispersion in a group of young women in the starvation phase of anorexia nervosa (AN) and its relation to left ventricular (LV) mass. STUDY DESIGN Sixteen patients with self-induced starvation were matched with 16 women of normal weight and 16 constitutionally thin women (body mass index <20 kg/m2). Starving patients and control patients underwent an electrocardiogram and echocardiogram. QT intervals were measured from surface electrocardiograms and QT dispersion was defined as the difference between maximum QT and minimum QT occurring in any of the 12 leads. RESULTS LV-chamber mass was significantly less in women with AN than in thin and normal-weight women. QT dispersion was significantly greater in AN than in the thin and control groups (QT dispersion: 50 +/- 14 vs 34 +/- 9 and 37 +/- 11 ms, P <.001; QT interval dispersion corrected for heart rate: 49+12 vs 34 +/- 9 and 36 +/- 7 ms, P <.01, respectively). A significant relation between QT dispersion and LV-mass index (r = -0.726, P <.01), and between QTc dispersion and LV mass index (r = -0.693, P < 0.01) were found only in the patients with AN. CONCLUSION Starving patients show an increased QT dispersion related to reduced LV mass. This result could represent a useful indicator of arrhythmic risk and sudden death in AN.
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Affiliation(s)
- Fabio Galetta
- Department of Internal Medicine, University of Pisa, San Miniato ASL, Italy
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Eidem BW, Cetta F, Webb JL, Graham LC, Jay MS. Early detection of cardiac dysfunction: use of the myocardial performance index in patients with anorexia nervosa. J Adolesc Health 2001; 29:267-70. [PMID: 11587910 DOI: 10.1016/s1054-139x(01)00255-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patients with anorexia nervosa have functional cardiac abnormalities secondary to their nutritionally depleted state. These abnormalities include decreased left ventricular (LV) mass and varying degrees of LV systolic dysfunction. Assessment of LV diastolic function and quantitative assessment of right ventricular function are not routinely performed. The myocardial performance index (MPI) is a relatively new, simple, quantitative measure of global myocardial function. The purpose of this study was to evaluate left and right ventricular function in 13 patients with anorexia nervosa with the MPI and compare it to more commonly used echocardiographic measures of ventricular function.
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Affiliation(s)
- B W Eidem
- Department of Pediatrics, Division of Pediatric Cardiology, Loyola University Medical Center, Maywood, Illinois, USA
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Welsh DC, Dipla K, McNulty PH, Mu A, Ojamaa KM, Klein I, Houser SR, Margulies KB. Preserved contractile function despite atrophic remodeling in unloaded rat hearts. Am J Physiol Heart Circ Physiol 2001; 281:H1131-6. [PMID: 11514279 DOI: 10.1152/ajpheart.2001.281.3.h1131] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The present study was designed to determine whether myocardial atrophy is necessarily associated with changes in cardiac contractility. Myocardial unloading of normal hearts was produced via heterotopic transplantation in rats. Contractions of isolated myocytes (1.2 mM Ca2+; 37 degrees C) were assessed during field stimulation (0.5, 1.0, and 2.0 Hz), and papillary muscle contractions were assessed during direct stimulation (2.0 mM Ca2+; 37 degrees C; 0.5 Hz). Hemodynamic unloading was associated with a 41% decrease in median myocyte volume and proportional decreases in myocyte length and width. Nevertheless, atrophic myocytes had normal fractional shortening, time to peak contraction, and relaxation times. Despite decreases in absolute maximal force generation (F(max)), there were no differences in F(max)/ area in papillary muscles isolated from unloaded transplanted hearts. Therefore, atrophic remodeling after unloading is associated with intact contractile function in isolated myocytes and papillary muscles when contractile indexes are normalized to account for reductions in cell length and cross-sectional area, respectively. Nevertheless, in the absence of compensatory increases in contractile function, reductions in myocardial mass will lead to impaired overall work capacity.
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Affiliation(s)
- D C Welsh
- Cardiovascular Research Group, Temple University Medical Center, Philadelphia, Pennsylvania 19140, USA
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39
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Umana E, Panayiotou H, Ramsey KA, Bikkina M, Massey CV, Alpert MA. Left ventricular mass and systolic function in human immunodeficiency virus-infected patients after weight loss. Am J Cardiol 2000; 86:1040-3, A11. [PMID: 11053726 DOI: 10.1016/s0002-9149(00)01148-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Transthoracic echocardiography was performed on 27 patients with human immunodificiency virus after weight loss and in 20 lean controls. Left ventricular mass index was significantly higher and left ventricular fractional shortening was significantly lower in patients with human immunodificiency virus after weight loss than in lean, normal controls.
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Affiliation(s)
- E Umana
- Division of Cardiology, University of South Alabama College of Medicine, Mobile 36617, USA
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Hill AA, Plank LD, Finn PJ, Whalley GA, Sharpe N, Clark MA, Hill GL. Massive nitrogen loss in critical surgical illness: effect on cardiac mass and function. Ann Surg 1997; 226:191-7. [PMID: 9296513 PMCID: PMC1190954 DOI: 10.1097/00000658-199708000-00011] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The authors measured cardiac mass and function to determine whether these changed in patients who were critically ill who were losing large amounts of nitrogen from the body. SUMMARY BACKGROUND DATA The large losses of body nitrogen that occur in patients with protein-energy malnutrition are associated with a loss of cardiac mass and function. It is not known if this also occurs in patients who were critically ill who are losing massive amounts of nitrogen. METHODS Once hemodynamically stable, 13 patients who were critically ill underwent sequential measurements of left ventricular mass (LVM) and function, total body nitrogen (TBN), total body potassium, body weight, fat-free mass, and limb muscle mass. RESULTS Over a 21-day study period, there was no change in LVM or function despite falls of 14% and 21% in TBN and total body potassium, respectively, a 21% fall in limb muscle mass, and a deterioration in skeletal muscle function by approximately 40%. CONCLUSIONS In patients who were critically ill, cardiac mass does not decrease and function does not deteriorate after hemodynamic stability has been achieved despite massive losses of protein from the body.
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Affiliation(s)
- A A Hill
- University Department of Surgery, Auckland Hospital, New Zealand
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42
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Aurigemma GP, Villegas B, Gaasch WH, Meyer TE. Noninvasive assessment of left ventricular mass, chamber volume, and contractile function. Curr Probl Cardiol 1995. [DOI: 10.1016/s0146-2806(06)80013-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
PURPOSE Medical information on male anorectics is scant. We present data on 10 males with anorexia nervosa, who were treated at our Eating Disorders Center during a twelve-year period. METHODS Retrospective chart review. RESULTS All patients were malnourished weighing 80% or less of their ideal body weight with a mean B.M.I. of 13.5 +/- 2.0. Height below the 50th percentile was evident in 80% of the patients, and was below the 10th percentile in 30% of the patients. Structural brain changes on brain computerized tomography scans were noted in seven out of nine patients and more than 50% had mild anemia relative to the Tanner stage. Other findings included a mean presenting heart rate of 68.3 +/- 17: four out of ten patients had presenting heart rates of 80 or greater and of these, three had serious medical problems and were severely malnourished. Two patients had cardiac complications and one had a life-threatening electrolyte disturbance. CONCLUSION Despite the small number of patients, the proportion of male adolescent anorectics with medical abnormalities seems high, and may be due to difficulties in establishing the diagnosis and delay in seeking medical attention. Patients who had heart rates of 80 or greater were perhaps sicker and further along in their development of congestive heart failure, thus explaining their initial relative tachycardia. We suggest a higher index of suspicion for congestive heart failure and closer medical monitoring when a malnourished adolescent with anorexia nervosa presents with relatively elevated heart rates.
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Affiliation(s)
- J H Siegel
- Division of Adolescent Medicine, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, New York 11042, USA
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Kreipe RE, Goldstein B, DeKing DE, Tipton R, Kempski MH. Heart rate power spectrum analysis of autonomic dysfunction in adolescents with anorexia nervosa. Int J Eat Disord 1994; 16:159-65. [PMID: 7987350 DOI: 10.1002/1098-108x(199409)16:2<159::aid-eat2260160207>3.0.co;2-h] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We studied autonomic modulation of heart rate in 8 females with anorexia nervosa (AN) using power spectral analysis (PSA) of heart rate variability in the supine and standing positions at baseline and after 2 weeks of intensive nutritional rehabilitation, and compared findings with healthy female control subjects. The results indicate that there is a decrease in sympathetic modulation of heart rate, evident by a deficit of low frequency (0.01-0.15 Hz) heart rate power in the supine position in AN compared with control subjects. In addition, parasympathetic modulation of heart rate failed to decrease with standing. A trend toward improvement in autonomic control of heart rate in adolescents with AN occurs in the supine position relatively early in weight rehabilitation. PSA is a sensitive, quantitative, and noninvasive means of determining autonomic control of heart rate and could be a useful tool in monitoring the health of patients with AN.
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Affiliation(s)
- R E Kreipe
- Adolescent Medicine Eating Disorders Program, University of Rochester Medical Center, New York 14642-8690
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Cittadini A, Cuocolo A, Merola B, Fazio S, Sabatini D, Nicolai E, Colao A, Longobardi S, Lombardi G, Saccà L. Impaired cardiac performance in GH-deficient adults and its improvement after GH replacement. THE AMERICAN JOURNAL OF PHYSIOLOGY 1994; 267:E219-25. [PMID: 8074201 DOI: 10.1152/ajpendo.1994.267.2.e219] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cardiac performance was investigated by radionuclide angiography in 11 patients with childhood-onset growth hormone (GH) deficiency and in 12 control subjects. Both at rest and during maximal physical exercise, systolic function was markedly depressed in GH-deficient patients. Ejection fraction rose from 66 +/- 6 to 76 +/- 7% during exercise in control subjects, whereas in GH-deficient patients it remained unchanged or even decreased (55 +/- 6 and 54 +/- 9% at rest and after exercise, respectively; P < 0.01 vs. controls). Cardiac index was significantly lower in GH-deficient patients than in controls, both at rest (2.7 +/- 0.6 vs. 3.7 +/- 0.5 l.min-1.m-2; P < 0.001) and during exercise (8 +/- 1.2 vs. 10 +/- 1.5 l.min-1.m-2; P < 0.01). Five GH-deficient patients were treated with recombinant human (rh) GH for 6 mo at a dose of 0.05 IU.kg-1.day-1. Cardiac index at rest improved from 2.8 +/- 0.6 to 3.3 +/- 0.8 l.min-1.m-2 (P < 0.01) after rhGH. Also, cardiac index response to exercise improved markedly and became similar to that of controls (7.5 +/- 1.2 and 10.1 +/- 1.1 l.min-1.m-2 before and after rhGH, respectively; P < 0.005). Exercise tolerance was impaired in GH-deficient patients and was restored by rhGH treatment. The data support the hypothesis that GH plays an important role in the maintenance of a normal cardiac performance in humans.
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Affiliation(s)
- A Cittadini
- Department of Internal Medicine, Federico II University Medical School, Naples, Italy
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de Simone G, Scalfi L, Galderisi M, Celentano A, Di Biase G, Tammaro P, Garofalo M, Mureddu GF, de Divitiis O, Contaldo F. Cardiac abnormalities in young women with anorexia nervosa. Heart 1994; 71:287-92. [PMID: 8142200 PMCID: PMC483668 DOI: 10.1136/hrt.71.3.287] [Citation(s) in RCA: 108] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE To identify the characteristics of cardiac involvement in the self-induced starvation phase of anorexia nervosa. METHODS Doppler echocardiographic indices of left ventricular geometry, function, and filling were examined in 21 white women (mean (SD) 22 (5) years) with anorexia nervosa according to the DSMIII (Diagnostic and Statistical Manual of Mental Disorders) criteria, 19 women (23 (2) years) of normal weight, and 22 constitutionally thin women (21 (4) years) with body mass index < 20. RESULTS 13 patients (62%) had abnormalities of mitral valve motion compared with one normal weight woman and two thin women (p < 0.001) v both control groups). Left ventricular chamber dimension and mass were significantly less in women with anorexia nervosa than in either the women of normal weight or the thin women, even after standardisation for body size or after controlling for blood pressure. There were no substantial changes in left ventricular shape. Midwall shortening as a percentage of the values predicted from end systolic stress was significantly lower in the starving patients than in women of normal weight: when endocardial shortening was used as the index this difference was overestimated. The cardiac index was also significantly reduced in anorexia nervosa because of a low stroke index and heart rate. The total peripheral resistance was significantly higher in starving patients than in both control groups. The left atrial dimension was significantly smaller in anorexia than in the women of normal weight and the thin women, independently of body size. The transmitral flow velocity E/A ratio was significantly higher in anorexia than in both the control groups because of the reduction of peak velocity A. When data from all three groups were pooled the flow velocity E/A ratio was inversely related to left atrial dimension (r = -0.43, p < 0.0001) and cardiac output (r = -0.64, p < 0.0001) independently of body size. CONCLUSIONS Anorexia nervosa caused demonstrable abnormalities of mitral valve motion and reduced left ventricular mass and filling associated with systolic dysfunction.
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Affiliation(s)
- G de Simone
- Clinical Nutrition Unit, Faculty of Medicine, Federico II University of Naples, Italy
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Affiliation(s)
- R E Kreipe
- Division of Adolescent Medicine, University of Rochester School of Medicine and Dentistry, New York 14642
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48
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Abstract
Malnutrition is associated with a number of systemic diseases that are often accompanied by severe exercise limitation. Anorexia nervosa (AN) is a disease characterized by malnutrition due to psychological factors rather than systemic disease. Diminished exercise capacity in AN has been attributed to a loss of muscle mass, dysfunction of remaining muscle, and impaired cardiovascular responses. In order to evaluate the role of malnutrition in the cardiopulmonary response to exercise, nine adolescent girls with AN were evaluated during progressive and steady-state exercise testing using a cycle ergometer. Nutritional status was assessed by body mass percentile (BMP) and percent ideal weight (PIWT). Cardiac output was measured by the indirect (CO2 rebreathing) Fick method. Maximum work capacity (Wmax) was expressed as a percent of predicted for sex and height, and cardiac output as a percent of predicted for oxygen consumption. To ensure that the laboratory values were comparable to the predicted values, a control group consisting of ten adolescents was studied concurrently. Wmax was below the 95% confidence interval in six of nine of the AN group (mean +/- SD: 70 +/- 22% predicted), whereas two of ten controls were below and one above this interval (112 +/- 37%). Wmax correlated with nutritional status (BMP: r = 0.75; P less than 0.001; PIWT: r = 0.8, P less than 0.001). Ventilatory responses for CO2 production at steady state and for Wmax were appropriate in both groups. Cardiac output was appropriate in both the controls (103 +/- 12%) and the AN group (104 +/- 14%).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- L Lands
- Montreal Children's Hospital Research Institute-McGill University, Canada
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Nash MS, Bilsker S, Marcillo AE, Isaac SM, Botelho LA, Klose KJ, Green BA, Rountree MT, Shea JD. Reversal of adaptive left ventricular atrophy following electrically-stimulated exercise training in human tetraplegics. PARAPLEGIA 1991; 29:590-9. [PMID: 1787983 DOI: 10.1038/sc.1991.87] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Left ventricular (LV) myocardial atrophy and diminished cardiac function have been shown to accompany chronic human tetraplegia. These changes are attributable both to physical immobilisation and abnormal autonomic circulatory regulation imposed by a spinal cord injury (SCI). To test whether exercise training increases LV mass following chronic SCI, 8 neurologically complete quadriplegic males at 2 SCI rehabilitation and research centres underwent one month of electrically-stimulated quadriceps strengthening followed by 6 months of electrically-stimulated cycling exercise. Resting M-mode and 2-D echocardiograms were measured before and after exercise training to quantify the interventricular septal and posterior wall thicknesses at end-diastole (IVSTED and PWTED, respectively), and the LV internal dimension at end-diastole (LVIDED). LV mass was computed from these measurements using standard cube function geometry. Results showed a 6.5% increase in LVIDED following exercise training (p less than 0.02), with increases in IVSTED and PWTED of 17.8 (p less than 0.002) and 20.3% (p less than 0.01), respectively. Computed LV mass increased by 35% following exercise training (p = 0.002). These data indicate that myocardial atrophy is reversed in tetraplegics following electrically-stimulated exercise training, and that the changes in cardiac architecture are likely to be the result of both pressure and volume challenge to the heart imposed by exercise.
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Affiliation(s)
- M S Nash
- Department of Orthopaedics and Rehabilitation, University of Miami School of Medicine, Florida 33136
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Kenny J, Plappert T, Sutton MS. Relationship between instantaneous trans-mitral blood flow velocity and instantaneous left ventricular volume in normal and hypertrophied hearts. Int J Cardiol 1991; 33:133-40. [PMID: 1834591 DOI: 10.1016/0167-5273(91)90161-h] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
We examined the relationship between trans-mitral blood flow velocity and left ventricular volume in normal and hypertrophied hearts using cross-sectional Doppler echocardiography. We studied 10 normal subjects and 19 patients with left ventricular hypertrophy, 9 with aortic stenosis and 10 with dilated cardiomyopathy. Trans-mitral Doppler flow velocity signals and cross-sectional echocardiograms of the left ventricular short and long axes were digitized in each patient to obtain instantaneous mitral flow velocity, instantaneous left ventricular volume, left ventricular mass, and left ventricular mass/volume ratio at end-diastole. Peak velocities during rapid filling (E wave) were similar in all three groups. Peak velocities during atrial systole (A wave) were significantly increased in aortic stenosis, (124 +/- 28 cm/sec); but were not different from normal in dilated cardiomyopathy (43 +/- 20 cm/sec versus 32 +/- 9 cm/sec). The peak A/E velocity ratio was elevated in aortic stenosis 1.47 +/- 0.30, but in dilated cardiomyopathy it was similar to normal hearts (0.47 +/- 0.23 versus 0.54 +/- 0.15). The percentages of left ventricular filling achieved at the time of the peak E wave, the end of rapid filling, and at the time of the peak A wave were similar in all three patient groups. There was no correlation between blood flow velocities at peak E wave, peak A wave or the A/E velocity ratio and left ventricular volume or mass. There was a significant correlation between peak A velocities and left ventricular muscle/cavity areas (r = 0.81; P less than 0.001). There was a similarly close correlation between the peak A/E velocity ratios and left ventricular muscle/cavity areas (r = 0.80; P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- J Kenny
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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