Why the study?
Cardiac involvement is frequent in anorexia nervosa and contributes to high morbidity and mortality, prompting the need to describe cardiac structural and functional abnormalities and correlate them with disease severity.
What are the cardiac structural and functional abnormalities in patients with Anorexia Nervosa, and how do they correlate with disease severity?
What are the cardiac structural and functional abnormalities in patients with Anorexia Nervosa, and how do they correlate with disease severity?
In patients with Anorexia Nervosa, severe disease is associated with smaller LV mass, pericardial effusion, and mitral valve prolapse, while 2D speckle tracking echocardiography can detect early subtle LV systolic dysfunction despite normal LVEF.
a) Anorexia Nervosa (AN) is an eating disorder with devastating physical consequences. Cardiac involvement is frequent and contributes to the high morbidity and mortality rates in these patients. In our study we aimed to describe the cardiac structural and functional abnormalities occurring in AN, correlating them with the severity of the disease. b) We enrolled 39 AN patients (mean age 22.17.1 years, mean BMI 152.1kg/m 2 ) referred to the psychiatric department of our hospital from September 2018 to June 2019. The cohort was composed by 20 (51.3%) patients with extreme AN (BMI<15 kg/m 2 ) and 19 (48.7%) patients with non-extreme AN (BMI>15 kg/m 2 ). All subjects underwent electrocardiogram (ECG) and two-dimensional Doppler echocardiography with speckle tracking echocardiographic (2D-STE)-derived strain imaging. c) ECG abnormalities were similar between patients with extreme and non-extreme AN. Left ventricular (LV) mass and cardiac chamber volumes were significantly smaller in patients with extreme AN, compared to patients with non-extreme AN. Patients with extreme AN had a significantly higher prevalence of pericardial effusion (PE) and mitral valve prolapse (MVP). 2DSTE-derived strain imaging documented a subtle LV systolic dysfunction in 21(53.8%) patients, despite a normal LV ejection fraction (LVEF) and without significant differences between the two sub-groups. Parameters of diastolic function were within the normal range. d) LV remodeling, PE and MVP correlated with the severity of the disease, on the contrary ECG abnormalities and parameters of LV systolic function did not. 2DSTE may uncover an early LV dysfunction in these patients, undetected by conventional echocardiography.
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Leonarda Galiuto (2020) studied this question.
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