Reduced hemodynamic load and cardiac hypotrophy in patients with anorexia nervosa.
BACKGROUND
Anorexia nervosa is associated with lower left ventricular mass (LVM) and systolic dysfunction. Whether these abnormalities reflect chronic protein-energy malnutrition or are primarily related to lower cardiac workload is unclear.


OBJECTIVE
The objective of the study was to verify whether low LVM in anorexia nervosa is explained by low hemodynamic load.


METHODS
Ninety-one women with anorexia nervosa [macro x +/- SD age: 20.5 +/- 6.1 y; body mass index (in kg/m(2)): 15.6 +/- 1.9; group 1] and 62 normal-weight female control subjects (age: 22.5 +/- 5.5 y; body mass index: 20.9 +/- 1.2; group 2) underwent Doppler echocardiography. LVM was evaluated as the percentage predicted by body height, sex, and stroke work (systolic blood pressure x stroke volume).


RESULTS
The left ventricular chamber dimension was smaller and the chamber walls were thinner in group 1 than in group 2, which resulted in significantly lower LVM and LVM indexes (P < 0.0001). Ejection fraction, heart rate, stroke volume, and cardiac output were significantly (P < 0.007) lower in group 1, but peripheral resistance was substantially higher (P < 0.0001). The deviation of LVM from predicted values was lower and the proportion of subjects with inadequate LVM was significantly higher in group 1 than in group 2 (P < 0.0001). This difference was attenuated after adjustment for body weight and heart rate. There were no relations between LVM and laboratory tests in group 1.


CONCLUSIONS
Anorexia nervosa is a condition of low hemodynamic load that leads to low LVM. Even with adjustment for stroke work, however, LVM is lower than would be predicted by height, because of the effect of body weight reduction (ie, wasting of lean body mass).
Romano
Carmela
C
Center for Obesity and Eating Disorders, Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples.
Chinali
Marcello
M
Pasanisi
Fabrizio
F
Greco
Rosanna
R
Celentano
Aldo
A
Rocco
Alessandra
A
Palmieri
Vittorio
V
Signorini
Ada
A
Contaldo
Franco
F
de Simone
Giovanni
G
D000328:Adult; D000856:Anorexia Nervosa / Q000473:pathology / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D002302:Cardiac Output / Q000502:physiology; D016022:Case-Control Studies; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006352:Heart Ventricles / Q000473:pathology* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D011502:Protein-Energy Malnutrition / Q000473:pathology / Q000503:physiopathology*; D013318:Stroke Volume / Q000502:physiology; D013851:Thinness / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*