Cardiac abnormalities in young women with anorexia nervosa.

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.

[1]  S B Heymsfield,et al.  Anorexia nervosa and sudden death. , 1985, Annals of internal medicine.

[2]  J. Laragh,et al.  Increased cardiac performance in mild essential hypertension. Left ventricular mechanics. , 1985, Hypertension.

[3]  A. DeMaria,et al.  Recommendations Regarding Quantitation in M-Mode Echocardiography: Results of a Survey of Echocardiographic Measurements , 1978, Circulation.

[4]  A. Keys,et al.  Drastic food restriction; effect on cardiovascular dynamics in normotensive and hypertensive conditions. , 1948, Journal of the American Medical Association.

[5]  D. Meyers,et al.  Mitral valve prolapse in anorexia nervosa. , 1986, Annals of internal medicine.

[6]  J. Miller,et al.  Myocardial lesions and heart failure in infantile malnutrition. , 1971, The American journal of tropical medicine and hygiene.

[7]  N. Reichek,et al.  Effects of reduced left ventricular mass on chamber architecture, load, and function: a study of anorexia nervosa. , 1985, Circulation.

[8]  N. Reichek,et al.  Noninvasive Determination of Left Ventricular End‐systolic Stress: Validation of the Method and Initial Application , 1982, Circulation.

[9]  R. Mazess,et al.  Skeletal and body-composition effects of anorexia nervosa. , 1990, The American journal of clinical nutrition.

[10]  E. Widdowson.  Biology of Human Starvation , 1952, Nature.

[11]  G. de Simone,et al.  Supernormal contractility in primary hypertension without left ventricular hypertrophy. , 1988, Hypertension.

[12]  S. Daniels,et al.  Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. , 1992, Journal of the American College of Cardiology.

[13]  A. Klibanski,et al.  Mechanisms of osteoporosis in adult and adolescent women with anorexia nervosa. , 1989, The Journal of clinical endocrinology and metabolism.

[14]  G. de Simone,et al.  Ambulatory blood pressure monitoring in offspring of hypertensive patients. Relation to left ventricular structure and function. , 1993, American journal of hypertension.

[15]  S. Heymsfield,et al.  Cardiac abnormalities in cachectic patients before and during nutritional repletion. , 1978, American heart journal.

[16]  W. Gaasch,et al.  Left Ventricular Midwall Mechanics in Systemic Arterial Hypertension Myocardial Function is Depressed in Pressure‐Overload Hypertrophy , 1991, Circulation.

[17]  J. Cunha.  General view on the criteria utilized for psychiatric diagnoses feighner research diagnostic criteria diagnostic and statistical manual of mental disorders dsm iii , 1986 .

[18]  P. Marks,et al.  Electrocardiographic abnormalities in patients with anorexia nervosa. , 1974, British heart journal.

[19]  A. Tajik,et al.  Assessment of diastolic function of the heart: background and current applications of Doppler echocardiography. Part II. Clinical studies. , 1989, Mayo Clinic proceedings.

[20]  J S Borer,et al.  Effects of Self-Induced Starvation on Cardiac Size and Function in Anorexia Nervosa , 1978, Circulation.

[21]  K. Gabriel,et al.  A Study of the Powers of Several Methods of Multiple Comparisons , 1975 .

[22]  S. M. Solomon,et al.  The refeeding syndrome: a review. , 1990, JPEN. Journal of parenteral and enteral nutrition.

[23]  A. Keys,et al.  The size and function of the human heart at rest in semi-starvation and in subsequent rehabilitation. , 1947, The American journal of physiology.

[24]  R. Cody,et al.  Comparative accuracy of Doppler echocardiographic methods for clinical stroke volume determination. , 1990, American heart journal.

[25]  W. Gaasch,et al.  Left ventricular chamber filling and midwall fiber lengthening in patients with left ventricular hypertrophy: overestimation of fiber velocities by conventional midwall measurements. , 1985, Circulation.

[26]  J. Laragh,et al.  Relation of left ventricular hemodynamic load and contractile performance to left ventricular mass in hypertension. , 1990, Circulation.

[27]  R. Pini,et al.  Mitral valve dimensions and motion and familial transmission of mitral valve prolapse with and without mitral leaflet billowing. , 1988, Journal of the American College of Cardiology.

[28]  I. Mirsky,et al.  Preload dependence of fiber shortening rate in conscious dogs with left ventricular hypertrophy. , 1990, Journal of the American College of Cardiology.

[29]  O. de Divitiis,et al.  Obesity and Cardiac Function , 1981, Circulation.

[30]  N Reichek,et al.  Echocardiographic Determination of Left Ventricular Mass in Man: Anatomic Validation of the Method , 1977, Circulation.