Heart rate variability and left ventricular diastolic function in anorexia nervosa.
OBJECTIVE
To investigate the cardiac effects of starvation in a group of adolescents with anorexia nervosa (AN).


METHODS
Twenty-five patients with AN (range 13-20 years), compared with 25 age-matched thin and 25 age-matched control women with body mass index > 20 Kg/m(2), underwent a complete clinical evaluation, including echocardiogram and 24-hour electrocardiogram monitoring to evaluate heart rate variability (HRV) indices.


RESULTS
Compared to both thin and control women, patients with AN had greater HRV time domain indices (SDNN: 246.5 +/- 32.4 vs. 170.4 +/- 24 ms and vs. 181 +/- 21.2 ms, p <.001), and in the frequency domain a lower LF/HF ratio (4.2 +/- 1.3 vs. 6.7 +/- 1.2 and vs. 6.8 +/- 1.3 ms, p <.001). AN patients showed reduced left ventricular mass with normal systolic function and typical diastolic patterns, characterized by a lower peak velocity transmitral flow in late diastole (peak A: 35.9 +/- 8.5 vs. 45.2 +/- 7.3 cm/sec and vs. 46.6 +/- 6.3 cm/sec, p <.01), a comparable peak velocity in early diastole (peak E: 92.7 +/- 12.1 vs. 83 +/- 6.2 and vs. 86.8 +/- 9.1 cm/sec, ns) and, subsequently, a greater E/A ratio (2.8 +/- 0.7 vs. 1.8 +/- 0.3 and vs. 1.9 +/- .5, p <.01) than thinness and control groups. Moreover, SDNN was also positively related to E/A ratio (r =.54, p <.01).


CONCLUSIONS
Our findings demonstrate a cardiovascular vagal hyperactivity in AN, which appears to influence the ventricular diastolic dynamics. HRV and diastolic function analysis may represent useful tools in monitoring anorexia-induced cardiac modifications.
Galetta
Fabio
F
Department of Internal Medicine, University of Pisa School of Medicien, Via Roma 67, 56126, Pisa, Italy. fgaletta@med.uni.pi
Franzoni
Ferdinando
F
Prattichizzo
Fernando
F
Rolla
Mimma
M
Santoro
Gino
G
Pentimone
Ferdinando
F
D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000150:complications / Q000503:physiopathology*; D000886:Anthropometry; D001794:Blood Pressure; D001919:Bradycardia / Q000209:etiology / Q000503:physiopathology*; D016022:Case-Control Studies; D018618:Echocardiography, Doppler, Color; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007558:Italy; D013217:Starvation / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology*