Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery

Abstract

The pathogenesis of different malnutrition diseases was suggested to affect the heart. This study was designed to detect cardiac affection in protein energy malnutrition (PEM) patients, whether clinically or by electrocardiogram (ECG) and echocardiogram, and to assess the value of the cardiac marker troponin I in patients at risk of myocardial injury with special emphasis on the effect of nutritional rehabilitation. The present study was carried out on 30 PEM infants (16 nonedematous - 14 edematous) and 10 apparently healthy age and sex-matched infants acting as the control group. All studied infants were subjected to full history taking laying stress on dietetic history, thorough clinical and anthropometric measurements. Echocardiography and ECG were also performed. Laboratory investigations were performed including complete blood count, CRP, total proteins, albumin, liver and kidney functions as well as estimation of troponin-I in blood by immulite. Following initial evaluation, all malnourished infants were subjected to nutritional rehabilitation program for approximately 8 weeks, after which the patients were re-evaluated using the same preinterventional parameters. The results of the present study demonstrated that electrical properties of myocardium assessed by ECG showed significant decrease of R wave and QTc interval in patients compared to controls with significant improvement after nutritional rehabilitation. Echocardigraphic changes showed that cardiac mass index was significantly lower in both groups of malnourished cases compared to the controls with significant increase after nutritional rehabilitation. The study showed that the parameters of left ventricular (LV) systolic function which are the ejection fraction, fractional shortening and velocity of circumferential fiber shortening were not significantly reduced in patients compared to the controls. The diastolic function also showed no significant difference in the E wave/A wave (e/a) ratio between patients and controls. However, the systolic time interval showed significantly higher LV pre-ejection index in patients in comparison to controls. Edematous and nonedematous cases did not show any significant differences in ECG and echocardigraphic data before or after nutritional rehabilitation. The hearts of two severely affected patients uniquely demonstrated marked decrease of LV end diastolic diameter (LEVDd) together with the detection of troponin-I in their sera. We can conclude that malnutrition, regardless of its type, has a definite effect on cardiac volume, muscle mass, as well as the electrical properties of the myocardium. The systolic functions of the heart are affected more than the diastolic functions and this affection becomes manifest only in severe cases and may constitute a bad prognostic parameter thus necessitating more intense management and strict follow-up of such cases.