Early detection of cardiac dysfunction in patients with anorexia nervosa by tissue Doppler imaging

Background: Cardiac damage is a major complication of chronic starvation. The aim of this study was to evaluate the changes of left ventricular function in patients with anorexia nervosa by means of pulsed tissue Doppler imaging. Methods: A total of 20 females (age 22.4±4.3 years) with overt anorexia nervosa, 20 matched healthy thin females with body mass index <19 kg/m2 and 20 matched healthy normal-weight females underwent both standard echocardiography and tissue Doppler imaging. Myocardial systolic wave (Sm) and early (Em) and atrial (Am) diastolic waves were measured on the basal lateral segment and the basal interventricular septum from the apical four-chamber view. Results: When compared with control groups, the anorexia nervosa group showed lower left ventricular mass (p<0.0001), lower Sm peak of both lateral wall (6.5±0.9 vs. 9.4±2.1 and vs. 9.5±1.9 cm/sec, p<0.001) and septum (5.6±1.5 vs. 8.6±1.6 and vs. 8.8±1.5 cm/sec, p<0.001), and comparable Em, Am and Em/Am ratio. The ratio between transmitral peak E and Em was significantly greater in anorexic patients than in controls (lateral wall: 8.1±0.1 vs. 6.8±0.2 and vs. 6.9±0.2, p<0.001; septum: 10.8±0.4 vs. 8.8±0.5 and vs. 8.8±0.3, p<0.001). No differences were observed between thin and normal-weight females. In the anorexia nervosa group, Sm peak was significantly related to left ventricular mass indexed, at both septum (r=0.55, p<0.02) and lateral wall (r=0.49, p<0.03) levels. Conclusions: These results show that anorexia nervosa is associated with left ventricular systolic dysfunction, which is related with the reduction of cardiac mass. Tissue Doppler imaging can give useful information in the identification of regional left ventricular dysfunction, in addition to traditional parameters.