Abstract
BackgroundAnorexia nervosa (AN) is accompanied by bradycardia, low blood pressure (BP) and cardiac morphological remodeling. Systolic and diastolic functions are relatively preserved when assessed by standard ultrasound methods. However, novel advances based on speckle tracking echocardiography (STE), that could detect subtle and early alterations of left ventricular (LV) function, remained poorly used in AN patients.ObjectiveThe aim of this study was to assess the cardiac function of AN patients by evaluating LV myocardial strains, myocardial work (MW) and LV mechanical dispersion. We hypothesized that LV strains and global myocardial work would be decreased and LV twisting mechanisms enhanced to preserve the systolic function.MethodsFifty-nine adolescents including 26 women AN patients (14.6 ± 1.9 yrs. old) with a mean duration of AN of 19 ± 9 months and 33 controls (14.1 ± 2.0 yrs. old) underwent STE to assess LV morphology and myocardial regional strains.ResultsThe global longitudinal strain (GLS) was higher in AN patients compared to controls (−18.8 ± 2.0 vs. −16.9 ± 2.8%, p = 0.006). The area under the pressure-strain loop, representing the global MW was not altered but was shifted to the left and downwards in AN patients, due to their lower BP and higher GLS. Intraventricular mechanical dispersion was similar in both groups. Circumferential strains, twisting/untwisting mechanics were preserved.ConclusionOur results strongly support that the cardiac morphological remodeling observed in our AN patients was associated with normal ventricular regional myocardial functions. Only GLS was higher in AN patients, but its clinical significance remains to be demonstrated.
Highlights
Anorexia nervosa (AN) is characterized by important weight loss, severe malnutrition and body composition abnormalities [1]
We considered Global longitudinal strain (GLS), circumferential strains and left ventricular (LV) twist as indices of myocardial systolic function, LSrdiast as index of LV relaxation [32] and peak untwisting rate as an index of LV diastolic suction
Percentage of body fat mass was lower and of lean mass was higher in AN patients compared to controls
Summary
Anorexia nervosa (AN) is characterized by important weight loss, severe malnutrition and body composition abnormalities [1]. The most common abnormalities reported are sinus bradycardia, Myocardial Strains in Anorexia Nervosa hypotension and electrocardiographic abnormalities [3]. A left ventricular (LV) remodeling has been observed, characterized by a diminished wall thickness due to the loss of cardiac muscle [2]. A specific LV filling profile is usually observed, with decreased A wave and increased E/A ratio, on account very likely to sinus bradycardia [2, 4]. Most of studies in AN patients referred to standard ultrasound methods, precluding any conclusion regarding their myocardial regional function. Anorexia nervosa (AN) is accompanied by bradycardia, low blood pressure (BP) and cardiac morphological remodeling. Systolic and diastolic functions are relatively preserved when assessed by standard ultrasound methods. Novel advances based on speckle tracking echocardiography (STE), that could detect subtle and early alterations of left ventricular (LV) function, remained poorly used in AN patients
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