Cardiac abnormalities inyoung women with anorexia nervosa

Objective-To identify thecharacteristics ofcardiac involvement intheself-induced starvation phaseofanorexia nervosa. Methods-Dopplerechocardiographic indices ofleft ventricular geometry, function,andfilling wereexaminedin21 whitewomen (mean(SD)22(5)years) withanorexia nervosaaccording tothe DSMIII (Diagnostic and Statistical ManualofMentalDisorders) criteria, 19 women (23(2)years) ofnormalweight, and22constitutionally thinwomen (21 (4)years) withbodymassindex<20. Results-13 patients (62%)hadabnormalities ofmitral valve motioncompared withonenormalweightwomanandtwo thinwomen (p< 0-001) v bothcontrol groups).Left ventricular chamber dimension andmassweresignificantly less inwomenwithanorexia nervosa than ineither thewomenofnormalweightor thethinwomen,evenafter standardisationforbodysizeorafter controlling for bloodpressure. Therewerenosubstantialchangesinleftventricular shape. Midwall shortening asapercentage ofthe values predicted fromendsystolic stress was significantly lowerinthestarving patients thaninwomenofnormalweight: whenendocardial shortening wasusedas theindexthisdifference wasoverestimated.Thecardiac indexwasalsosignificantly reducedin anorexianervosa because ofalowstroke indexandheart rate. Thetotal peripheral resistance was significantly higher instarving patients thaninbothcontrol groups.The left atrial dimension wassignificantly smaller inanorexia thaninthewomenofnormal weightandthethinwomen,independently ofbodysize. Thetransmitral flow velocity EIAratio wassignificantly higher inanorexia thaninboththecontrol groupsbecause ofthereduction ofpeak velocity A. When datafromallthree groups werepooled theflowvelocity EIA ratio wasinversely related toleft atrial dimension(r= -043,p < 0.0001) and cardiacoutput(r= -0-64,p < 0.0001) independently ofbodysize. Conclusions-Anorexia nervosacaused demonstrable abnormalities of mitral valve motionandreduced left ventricular massandfilling associated withsystolic dysfimction.