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Echocardiographic changes in anorexia nervosa: a pathophysiological adaptation or a disease?

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Abstract

Anorexia Nervosa is one of the most common form of eating disorders. Cardiac involvement occurs in approximately 80% of patients. Few reports focused on the association between body weight fluctuations and echocardiographic abnormalities, considering linear measurements. We describe echocardiographic and clinical features among male and female patients with anorexia nervosa and the effect of weight gain on these parameters. We performed a single center, retrospective study of patients followed at a dedicated multidisciplinary Unit. The study population consisted of 81 patients, mean age 25 ± 11 years, 94% female. Median body mass index was 14.4 kg/m2 (25th–75th percentile 12.7–15.6 kg/m2). Patients with body mass index below the median value had more often pericardial effusion, smaller left ventricular mass and left ventricular end-diastolic volume and thinner interventricular septum. However, when indexed to body surface area, left ventricular mass and volumes were within the normal range in 90% of population. Patients with pericardial effusion showed mitral valve abnormalities and lower values of white blood cells and platelets, although within normal limits. Presence of pericardial effusion was not related to inflammatory parameters or low plasma protein levels. In 39 patients who displayed weight gain during a median follow-up of 189 days (25th–75th percentile 47–471), increased left ventricular mass, interventricular septum thickness, white blood cells and platelet count and decreased pericardial effusion were observed. Patients with anorexia nervosa have a specific echocardiographic pattern which seems to be proportional to the body size, suggesting a pathophysiological adaptation to the lack of substrates.

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Acknowledgements

We thank Doctor Elena Epis and Doctor Emilio Bergamelli for the contribution in data collection and our sonographer, Alessia Zaniboni and Dario Sansalone, for the high quality of their work.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy

    G. Santangelo, F. Bursi, F. Toriello & L. Massironi

  2. Division of Internal Medicine, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy

    M. E. Tamagni, A. Fanin & A. Benetti

  3. Division of Psychiatry, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy

    G. Fior, S. Bertelli & O. Gambini

  4. Division of Cardiology, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

    S. Carugo

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  1. G. Santangelo
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  4. M. E. Tamagni
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  9. O. Gambini
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All authors contributed equally to the manuscript and read and approved the final version of the manuscript.

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Correspondence to G. Santangelo.

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All study procedures were approved by the Partners Healthcare Institutional Review Board (protocol number 2020/ST/193) and carried out in accordance with the Declaration of Helsinki.

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Santangelo, G., Bursi, F., Toriello, F. et al. Echocardiographic changes in anorexia nervosa: a pathophysiological adaptation or a disease?. Intern Emerg Med 17, 777–787 (2022). https://doi.org/10.1007/s11739-021-02871-0

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  • DOI: https://doi.org/10.1007/s11739-021-02871-0

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