Abstract 12369: Adolescents With Eating Disorders Undergo Cardiac Remodeling

Abstract

Introduction: Patients with eating disorders (ED) such as anorexia and bulimia nervosa are known to have increased cardiac mortality. The exact etiology of this predisposition is unclear. Hypothesis: ED pts have changes in their cardiac structure and function in adolescence that may alter their outcomes. Methods: All ED pts who had an echocardiogram between Jan 2005 - Dec 2020 were included. Patients with congenital heart disease and with poor image quality were excluded. Measurements of systolic and diastolic indices, including mass and volume (5/6 area length method) were made. Standard statistics were performed and pts with BMI < 5% (LBMI) (n=40) were compared to pts with BMI >5% (NBMI, n=36) using Student’s t test. A p value < 0.05 was considered significant. Results: In all, 78/136 pt echos met inclusion criteria. The median age was 16 (12-20) years. The mean BMI was 16.8 + 2.8 kg/sq.m. (LBMI 14.7 + 1.7, NBMI 19.2 + 2.1, p <0.01). Overall, left ventricular mass indexed (LVMI) was 23.2 + 6.8 gm/^height*2.7 with lower LVMI in LBMI (21.8 + 8) than NBMI (24.5 + 5; p=0.05). LV diastolic volumes were higher in LBMI pts (92.1 + 28.9 ml, z score -0.5 + 1.2) than NBMI pts (106 + 26 ml, z score -1.01 + 1.33; p=0.05)(overall 99.4 + 28.2 ml). Concurrently, ejection fraction was higher in LBMI pts (62 + 7% vs NBMI 58 + 5%; p=0.02) (overall 60 + 6%). Diastolic function was within normal range but different between the groups, consisting of mitral valve E/A (LBMI 2.7 + 1.04 vs NBMI 2.3 + 0.7; p=0.05)(overall 2.5 + 0.9), lateral E/e’ (LBMI 5.5 + 1.5 vs NBMI 4.5 + 1.3; p <0.01) (overall 5.0 + 1.5). Left atrial indexed volumes were similar between the groups (LBMI 18 + 6.5 vs NBMI 17.7 + 6.8; p=0.44)(overall 17.9+6.6). Aortic root z scores were higher in LBMI pts (0.01 + 1 vs NBMI -0.4 + 0.8; p=0.03)(overall -0.2 + 0.9). Other abnormalities on echo included mitral valve redundancy/regurgitation in 18% (5 LBMI, 9 NBMI), mild aortic regurgitation in 7% (2 LBMI 4 NBMI) and hemodynamically insignificant pericardial effusions in 9% (6 LBMI, 1O NBMI). Conclusions: Myocardial remodeling occurs in LBMI pts with lower LV mass and higher volumes. Further quantification of myocardial function using speckle tracking and longitudinal follow up may help understand progression and determine the risk for sudden death in these pts.