Cardiac function in malnourished anorexia nervosa patients: A clinical, biological and echocardiographic study

Abstract

Severe undernourished anorexia nervosa (AN) patients can have cardiac abnormalities. We aimed: – to characterize cardiac abnormalities and determine their prevalence before refeeding; – to describe clinical and biological parameters associated with cardiac abnormalities. Doppler echocardiography was performed inpatients in a median of 3 (1–9) days after admission and data were compared with control group. In a subset of patients, a second cardiac evaluation was performed after one month of enteral refeeding. One hundred and twenty-four patients were included in our study: age = 30.1 years, BMI: 12.3, 70% had restrictive type of AN. 11% of patients disclosed a left ventricular ejection fraction (LVEF) < 50%, correlated with purgative type of anorexia ( P < 0.017) and hypertransaminasemia ( P < 0.05). LVEF impairment was more frequent inpatients than in control group ( P = 0.05). LV end diastolic diameter (LVEDD), end diastolic interventricular septum thickness (IVS) and end diastolic posterior wall thickness (PW) were reduced compared to control group. LV diastolic parameters alteration was correlated with low free fat mass index (FFMI) and with hypertransaminasemia. After one month of enteral refeeding, BMI increased ( P < 0.05) while LVEF remained abnormal in only one patient. Patients with AN had infraclinical cardiac dysfunction, associated with severity of malnutrition, purgative type of AN and hypetransaminasemia. Cardiac function was impaired in 11% of patient (LVEF < 50%). Structural parameters were if reduced at baseline, improved after 1 month of nutritional care.