Left ventricular mass and function in children with severe protein energy malnutrition

Abstract

We studied 25 children, aged 1–5 years (mean 2.65 ± 0.8 years) with severe protein energy malnutrition, and compared their left ventricular mass and function to those of 26 healthy, age- and sex-matched normal children. The mean left ventricular mass in the patients was lower than that in the controls (25.75 ± 8.09 g vs. 32.44 ± 11.64 g; P < 0.05, C.I. 2.08 to 11.30). However, left ventricular mass (g)/kg body weight was significantly increased in the patients (4.44 ± 1.45 vs. 2.42 ± 0.87; P < 0.001, C.I. 1.28 to 2.76) suggesting relative cardiac “sparing”. The systolic function indices like ejection fraction, percentage fractional shortening, and velocity of circumferential fiber shortening were not significantly different in the patients and in the normal children. The left ventricular end-diastolic volume, stroke volume and cardiac output were reduced in proportion to decrease in body size in the patients, so that the cardiac index was not reduced but slightly increased in the patients. (5.95 ± 1.9 l/min/m 2 in patients, 4.97 ± 1.4 l/min/m 2 in controls; P < 0.05, C.I. 0.04 to 1.92). There was no significant difference in any of these parameters of left ventricular function or mass in patients with marasmus, as compared to those of patients with marasmic kwashiorkor. Amongst the 25 patients, however, 5 patients (20%) had an ejection fraction of less than 50%. Compared to the other 20 patients, these 5 patients had lower left ventricular mass (18.4 ± 4.3 g vs. 27.5 ± 7.8 g, P < 0.05 C.I. 1.63 to 16.75), lower left ventricular mass (g)/kg body weight and a worse prognosis. These 5 patients did not differ from the rest of the patients in any other identifiable respect. Further characterisation of such patients may have wider physiological implications. In conclusion: (1) relative cardiac “sparing” occurs in patients with severe protein energy malnutrition; (2) the systolic functions are preserved in the atrophic hearts in most of the patients; and (3) in a small number of patients (20%), with equally severe malnutrition, more myocardial atrophy, reduced ejection fraction and a worse prognosis are seen.