An Echocardiographic Study of Cardiac Size and Function in Adolescent Females with Anorexia Nervosa
Dr. Carolina Escudero, Cardiology Fellow, won Best Fellow Research Paper and will represent the Department of Pediatrics at the 26th Annual National Pediatric Resident and Fellows Research Competition in Winnipeg, Manitoba, Canada on May 15, 2014.
Carolina Escudero, P-Y Lam, AM De Souza, JE Potts, GGS Sandor [Division of Cardiology]
Background: Cardiac involvement occurs in the majority of patients with Anorexia Nervosa (AN), however, controversy still exists regarding systolic and diastolic function in females with AN. The purpose of our study was to investigate echocardiographic indices of cardiac dimensions, output, and systolic and diastolic function in adolescent females with AN.
Methodology: We performed a retrospective case-control study of adolescent females with AN compared to healthy adolescent controls. A complete echocardiogram including a detailed left ventricular (LV) function protocol was performed for controls and patients with AN during their acute phase of illness. LV dimensions, LV mass (LVM), LV mass indexed for body surface area (LVMI), left atrial (LA) size, stroke volume (SV), cardiac output (CO), and cardiac index (CI) were measured. LV systolic function was measured using fractional shortening (FS), mean velocity of circumferential fiber shortening (MVCFc), and systolic tissue Doppler imaging (TDI) at the LV lateral wall (LVlateral), interventricular septum (IVS), and right ventricular free wall (RV). Diastolic function was measured using transmitral E and A wave velocity, pulmonary venous velocities, and diastolic TDI E’ and A’ wave velocities. BMI percentiles were calculated for patients and controls and patients were divided into those of BMI ≤10th percentile (AN≤10th) and >10th percentile (AN>10th).
Results: We studied 95 adolescent AN patients (ANtotal) and 58 healthy adolescent female controls. There were 70 patients in the AN≤10th group. ANtotal and AN≤10th groups had reduced LV dimensions, LA size, LVM, LVMI, SV, CO, and CI compared to controls, with no differences between AN>10th and controls. There were no differences between controls and all AN groups in FS, MVCFc, or systolic TDI. Pulmonary venous A wave velocity was significantly decreased in ANtotal and AN≤10th as compared to controls with no difference in transmitral E or A wave velocity or E/A. LVlateral E’ and A’, IVS E’ and A’, and RV A’ were significantly decreased in ANtotal and AN≤10th, with only a decrease in RV A’ in AN>10th as compared to controls.
Conclusions: Adolescent females with AN have downsized LV dimensions, LVMI, and CI, but systolic ventricular function remains preserved. Diastolic function is decreased in AN patients. This is the first study to show that patients with BMI ≤10th percentile demonstrate changes in LV dimensions and diastolic function and warrant more careful monitoring.
Many thanks to Dr. Jean-Paul Collet, Celebrate Pediatric Research Day Program Chair and our Research Paper Competition Judges: Dr. Clara van Karnebeek, Dr. Kyla Hildebrand, and Dr. Connie Yang