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Anorexia nervosa–related cardiopathy in children with physical instability: prevalence, echocardiographic characteristics and reversibility at mid-term follow-up

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Abstract

Prompt detection of cardiovascular abnormalities in children with anorexia nervosa and physical instability requiring hospitalization is essential to identify patients at higher cardiovascular risk. We studied all anorexia nervosa children requiring admission at Paediatric Institute in the period 2015–2019. Anorexia nervosa cardiopathy at admission was defined by the presence of at least two of the following clinical findings: pericardial effusion, mitral regurgitation, bradycardia, mitral billowing, aortic regurgitation, altered LV morphology and ECG abnormalities. Echocardiographic data were compared with those registered at 3–8-month follow-up and with data from a healthy population. Thirty-eight anorexia nervosa children were examined. Prevalence of anorexia nervosa cardiopathy at admission was 63% (24 patients). Pericardial effusion, bradycardia and mitral regurgitation were present together in 26% of patients. Most cardiovascular changes recovered at follow-up. Anorexia nervosa cardiopathy was associated with significantly lower left ventricle end-diastolic diameters and mass, and higher E wave, E/A and E/e′ ratios and left ventricle sphericity index values vs healthy population and vs anorexia nervosa children without cardiopathy (p<0.05). Left ventricle global longitudinal strain was significantly reduced only in anorexia nervosa cardiopathy patients but recovered, whereas end-diastolic diameters, E/A ratio and sphericity index values remained impaired.

Conclusion: Among anorexia nervosa children requiring hospitalization, those presenting several cardiac findings together express an acute anorexia nervosa cardiopathy which is characterized by worse LV filling, geometry and subclinical myocardial deformation impairment. Despite treatment, in those patients, some alterations persist at mid-term follow-up.

What is Known:

• Cardiac and electrocardiographic changes are present in anorexia nervosa children at diagnosis or during stable disease, and most recover after body-weight treatment.

• It is unknown if anorexia nervosa children with more severe cardiac impairment during hospitalization present higher cardiovascular-risk profile despite treatment.

What is New:

• In anorexia nervosa children needing hospitalization for physical reasons, prevalence of acute anorexia nervosa cardiopathy at admission is high, around 60%.

• By advanced echocardiography, children with anorexia nervosa cardiopathy at admission have a worse cardiac filling, impaired cardiac geometry and systolic deformation that only partially recover at mid-term follow-up.

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Abbreviations

LV:

Left ventricle

LVEDd:

Left ventricle end diastolic diameter

LVESD:

Left ventricle end systolic diameter

IVSd:

Interventricular septal wall thickness in diastole

LVMI:

Indexed left ventricle mass

LV-GLS:

Left ventricle global longitudinal strain

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Authors and Affiliations

  1. Pediatric and Growing-up Cardiology Program, Division of Cardiology, Dpt of Advanced Biomedical Sciences, Federico II University, Naples, Italy

    Francesco Borgia, Plinio Cirillo, Danilo Franco, Giovanni Esposito & Nicola De Luca

  2. Child and Adolescent Neuropsychiatric Unit, Divison of Pediatrics, Dpt of Translational Medical Sciences, Federico II University, Naples, Italy

    Maria Pia Riccio, Francesco Raimondi, Luigi Scippa, Adriana Franzese & Carmela Bravaccio

Authors
  1. Francesco Borgia
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  2. Plinio Cirillo
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  3. Maria Pia Riccio
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  4. Francesco Raimondi
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  5. Danilo Franco
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  6. Luigi Scippa
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  7. Adriana Franzese
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  8. Giovanni Esposito
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  9. Nicola De Luca
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  10. Carmela Bravaccio
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Contributions

Francesco Borgia: conception and drafting the manuscript; Plinio Cirillo: design and drafting; Maria Pia Riccio: data collection; Francesco Raimondi: supervision; Danilo Franco: data collection; Luigi Scippa: data acquisition; Adriana Franzese: study conception; Giovanni Esposito: supervision and design; Nicola De Luca: supervision and design; Carmela Bravaccio: supervision and design.

Corresponding author

Correspondence to Francesco Borgia.

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All patients expressed by the parents the consent to participate to the cardiological assessment and study.

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Borgia, F., Cirillo, P., Riccio, M.P. et al. Anorexia nervosa–related cardiopathy in children with physical instability: prevalence, echocardiographic characteristics and reversibility at mid-term follow-up. Eur J Pediatr 180, 3379–3389 (2021). https://doi.org/10.1007/s00431-021-04130-y

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  • DOI: https://doi.org/10.1007/s00431-021-04130-y

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