European Child & Adolescent Psychiatry

, Volume 21, Issue 1, pp 15–21 | Cite as

Echocardiographic findings in adolescents with anorexia nervosa at beginning of treatment and after weight recovery

  • Sabrina Kastner
  • Harriet Salbach-Andrae
  • Babette Renneberg
  • Ernst Pfeiffer
  • Ulrike Lehmkuhl
  • Lothar Schmitz
Original Contribution


Anorexia nervosa (AN) is an eating disorder with somatic complications. The aim of the study was to analyse echocardiographic abnormalities in patients with AN at initial examination and after weight restoration. A total of 173 consecutively admitted adolescents (aged 12–17 years), diagnosed with DSM-IV AN (307.1) were evaluated in a child and adolescent psychiatric department of a major university hospital from December 1997 to August 2008. In addition, 40 healthy adolescents of the same age with normal weight were examined. In patients with AN, 34.7% had a pericardial effusion (PE) which was clinically silent. In contrast, none of the controls presented with PE (p < 0.001). No differences across AN subtypes were observed. Patients with PE showed significantly lower body mass index (BMI) (p = 0.016) than patients without PE. They had more prominent low-T3 syndrome (p = 0.003) and longer duration of hospitalisation (p = 0.008) after controlling for BMI at admission. Remission of PE was observed in 88% of the patients after weight restoration. Left ventricular end-diastolic and end-systolic dimensions in AN were significantly lower than in controls (p < 0.001). There were no differences in interventricular septum thickness, posterior wall thickness and fractional shortening. This report indicates that adolescents with AN show cardiac abnormalities in comparison to healthy young women. Furthermore, PE is a frequent cardiac complication in patients with AN and it is associated with BMI, low T3 serum levels and duration of hospitalisation.


Anorexia nervosa Adolescents Echocardiography Pericardial effusion T3 syndrome 


Conflict of interest



  1. 1.
    Katzman DK (2005) Medical complications in adolescents with anorexia nervosa: a review of the literature. Int J Eat Disord 37:S52–S59PubMedCrossRefGoogle Scholar
  2. 2.
    Palla B, Litt IF (1988) Medical complications of eating disorders in adolescents. Pediatrics 81:613–623PubMedGoogle Scholar
  3. 3.
    Sharp CW, Freeman CP (1993) The medical complications of anorexia nervosa. Br J Psychiatry 162:452–462PubMedCrossRefGoogle Scholar
  4. 4.
    Rome ES, Ammerman S (2003) Medical complications of eating disorders: an update. J Adolesc Health 33:418–426PubMedGoogle Scholar
  5. 5.
    Mitchell JE, Crow S (2006) Medical complications of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry 19:438–443PubMedCrossRefGoogle Scholar
  6. 6.
    Casiero D, Frishman WH (2006) Cardiovascular complications of eating disorders. Cardiol Rev 14(5):227–231PubMedCrossRefGoogle Scholar
  7. 7.
    Dec GW, Biederman J, Hougen TJ (1987) Cardiovascular findings in adolescent inpatients with anorexia nervosa. Psychosom Med 49:285–290PubMedGoogle Scholar
  8. 8.
    Panagiotopulus C, McCrindle BW, Hick K, Katzman DK (2000) Electrocardiographic findings in adolescents with eating disorders. Pediatrics 105:1100–1105CrossRefGoogle Scholar
  9. 9.
    Galetta F, Franzoni F, Cupisti A, Belliti D, Prattichizzo F, Rolla M (2002) QT interval dispersion in young women with anorexia nervosa. J Pediatr 140:456–460PubMedCrossRefGoogle Scholar
  10. 10.
    Gottdiener JS, Gross HA, Henry WL, Borer JS, Ebert WS (1978) Effects of self-included starvation on cardiac size and function in anorexia nervosa. Circulation 58:425–433PubMedGoogle Scholar
  11. 11.
    St. John Sutton MG, Plappert T, Crosby L, Douglas P, Mullen J, Reichek N (1985) Effects of reduced left ventricular mass on chamber architecture, load, and function: a study of anorexia nervosa. Circulation 72:991–1000PubMedCrossRefGoogle Scholar
  12. 12.
    De Simone G, Scalfi L, Galderisi M, Celentano A, Di Biase G, Tammaro P, Garofalo M, Mureddu GF, de Divitiis O, Contaldo F (1994) Cardiac abnormalities in young women with anorexia nervosa. Br Heart J 71:287–292PubMedCrossRefGoogle Scholar
  13. 13.
    Galetta F, Franzoni F, Prattichizzo F, Rolla M, Santoro G, Pentimone F (2003) Heart rate variability and left ventricular diastolic function in anorexia nervosa. J Adolesc Health 32:416–421PubMedCrossRefGoogle Scholar
  14. 14.
    Olivares JL, Vázquez M, Fleta J, Moreno LA, Pérez-Gonzalez JM, Bueno M (2005) Cardiac findings in adolescents with anorexia nervosa at diagnosis and after weight restoration. Eur J Pediatr 164:383–386PubMedCrossRefGoogle Scholar
  15. 15.
    Vázquez M, Olivares JL, Fleta J, Lacambra I, González M (2003) Cardiac disorders in young women with anorexia nervosa. Revista Española de Cardiología 56(7):669–673PubMedCrossRefGoogle Scholar
  16. 16.
    Mont L, Castro J, Herreros B, Paré C, Azqueta M, Magriña J, Puig J, Toro J, Brugada J (2003) Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery. J Am Acad Child Adolesc Psychiatry 42:808–813PubMedCrossRefGoogle Scholar
  17. 17.
    Meyers DG, Starke H, Pearson PH, Wilken MK (1986) Mitral valve prolapse in anorexia nervosa. Ann Intern Med 105:384–386PubMedGoogle Scholar
  18. 18.
    Slivka M, Buckelew S, Shafer M-A, Mosicki A-B, Garber A (2009) Cardiac findings among adolescents on first hospital admission for medical complications of anorexia nervosa. J Adolesc Health 44(2) Suppl. 1, S4Google Scholar
  19. 19.
    Silverman JA, Kongrad E (1983) Anorexia: a case of pericardial effusion? Pediatr Cardiol 4:125–127PubMedCrossRefGoogle Scholar
  20. 20.
    Moodie DS, Salcedo E (1983) Cardiac functions in adolescents and young adults with anorexia nervosa. J Adolesc Health 4:9–14CrossRefGoogle Scholar
  21. 21.
    Goldberg SJ, Comerci GD, Feldman L (1988) Cardiac output and regional myocardial contraction in anorexia nervosa. J Adolesc Health Care 9:15–21PubMedCrossRefGoogle Scholar
  22. 22.
    Lupoglazoff JM, Berkane N, Denjoy I, Maillard G, Leheuzey MF, Mouren-Simenoi MC, Casaoprana A (2001) Cardiac consequences of adolescent anorexia nervosa. Archives des maladies du coeur et des vaisseaux 94:494–498 (Abstract)PubMedGoogle Scholar
  23. 23.
    Silvetti MS, Magnani M, Santilli A, Di Liso G, Diamantini A, Pomei E et al (1998) The heart of anorexia adolescents. Giornale italiano di cardiologia 28:131–139 (Abstract)PubMedGoogle Scholar
  24. 24.
    Facchini M, Sala L, Malfatto G, Bragato R, Redalli G, Invitti C (2006) Low-K+ dependent QT prolongation and risk for ventricular arrhythmia in anorexia nervosa. Int J Cardiol 106:170–176PubMedCrossRefGoogle Scholar
  25. 25.
    Walter J von, Werner R, Rosefeldt H, Häßler A, Emmrich P (1996) Echokardiographische Veränderungen bei Patienten mit Anorexia nervosa. Monatszeitschrift Kinderheilkunde 144:1342–1351Google Scholar
  26. 26.
    Frölich J, von Gontard A, Lehmkuhl G, Pfeiffer E, Lehmkuhl U (2001) Pericardial effusions in anorexia nervosa. Eur Child Adolesc Psychiatry 10:54–57PubMedCrossRefGoogle Scholar
  27. 27.
    Ramacciotti CE, Coli E, Biadi O, Dell’Osso L (2003) Silent pericardial effusion in a sample of anorexic patients. Eating Weight Disord 8:68–71Google Scholar
  28. 28.
    Polli N, Blengino S, Moro M, Zappulli D, Scacchi M, Cavagnini F (2006) Pericardial effusions requiring pericardiocentesis in a girl with anorexia nervosa. Int J Eat Disord 39:609–611PubMedCrossRefGoogle Scholar
  29. 29.
    Cho YK, Yang SJ, Ma JS (2008) Pericardial effusion in three cases of anorexia nervosa. Korean J Pediatr 51:209–213CrossRefGoogle Scholar
  30. 30.
    Inagaki T, Yamamoto M, Tsubouchi K, Miyaoka T, Uegaki J, Maeda T et al (2003) Echocardiographic investigation of pericardial effusion in a case of anorexia nervosa. Int J Eat Disord 33:364–366PubMedCrossRefGoogle Scholar
  31. 31.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (DSM-IV) 4th edn, APA, Washington, DCGoogle Scholar
  32. 32.
    Fichter MM, Quadflieg N (1999) Strukturiertes Interview für Anorektische und Bulimische Essstörungen (SIAB). Fragebogen (SIAB-S) und Interview (SIAB-EX) nach DSM-IV und ICD-10. Handanweisung. Göttingen, HogrefeGoogle Scholar
  33. 33.
    Franke GH (2002) Symptom-Checkliste von L. R. Derogatis (SCL-90-R)-Deutsche Version. Göttingen, Beltz Test GmbHGoogle Scholar
  34. 34.
    Englert E, Poustka F (1995) Das Frankfurter Kinder- und Jugendpsychiatrische Dokumentationssystem. Praxis für Kinderpsychologie und Kinderpsychiatrie 44:158–167Google Scholar
  35. 35.
    Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ et al (2004) American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 17:1086–1119PubMedGoogle Scholar
  36. 36.
    Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA et al (2005) American Society of Echocardiography recommendations for chamber quantification: a report from the American Society of Echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463PubMedCrossRefGoogle Scholar
  37. 37.
    Maisch B, Seferović PM, Ristić AD, Erbel R, Rienmüller R, Adler Y et al (2004) Guidelines on the diagnosis and management of pericardial diseases. Executive summary. Eur Heart J 25:587–610PubMedCrossRefGoogle Scholar
  38. 38.
    Saito Y, Donohue A, Attai S, Vahdat A, Brar V, Handapangoda I et al (2008) The syndrome of cardiac tamponade with “small” pericardial effusion. Echocardiogr J Cardiovasc Ultrasound Allied Tech 25:321–327Google Scholar
  39. 39.
    Ahmad S, Ellis J, Nesbitt A, Molyneux E (2008) Pericardial effusions in children with severe protein energy malnutrition resolve with therapeutic feeding: a prospective cohort study. Arch Dis Child 93:1033–1036PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Sabrina Kastner
    • 1
  • Harriet Salbach-Andrae
    • 1
  • Babette Renneberg
    • 2
  • Ernst Pfeiffer
    • 1
  • Ulrike Lehmkuhl
    • 1
  • Lothar Schmitz
    • 3
  1. 1.Department of Child and Adolescent PsychiatryCharité-Universitätsmedizin BerlinBerlinGermany
  2. 2.Department of Psychology, Division of Clinical Psychology and PsychotherapyFreie Universität BerlinBerlinGermany
  3. 3.Department of Pediatrics, Division of CardiologyCharité-Universitätsmedizin BerlinBerlinGermany

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