Assessment of left ventricular systolic and diastolic functions in severely malnourished children

Abstract

Background: Malnourished children endure many changes in body composition and lose heart and skeletal muscle mass. Diastolic dysfunction is one of the major causes of heart failure with preserved ejection fraction. Aim: To assess left ventricular systolic and diastolic functions in children with severe acute malnutrition using tissue Doppler imaging technique and to evaluate the effect of nutritional rehabilitation. Patients and Methods: A follow-up case-control study conducted on 60 severely malnourished children (WHZ <-3SD) and 120 age and sex-matched healthy children as a control group. Tissue Doppler imaging (TDI) was done for all included malnourished children at admission and for control to measure left ventricular systolic and diastolic functions. Nutritional rehabilitation was done according to WHO protocol and tissue doppler was repeated after rehabilitation when (WHZ >-2SD) to detect any changes in systolic or diastolic functions. Results: Systolic function was normal in malnourished children and control. Grade I diastolic dysfunction was detected in 40% and grade II in 30% of severely malnourished children in comparison to 100% normal diastolic function in control group. No correlations between diastolic dysfunction and either anthropometric measurements, electrolyte disturbances or Hb% in malnourished children before nutritional rehabilitation. Mortality from sepsis with associated ventricular dysfunction grade II documented in 3.3% of malnourished children. After nutritional rehabilitation diastolic function improved significantly as 65.6% of children attained normal diastolic function, 31% grade1 and 3.4% grade II. Positive correlations between diastolic function and WAZ, HAZ, WHZ and MUAC after rehabilitation. Conclusion: Severe acute malnutrition affects diastolic function in children which is reversible in most of these cases with rehabilitation. TDI is an easy and practical method for detection and follow-up of ventricular function in malnourished children.

Early marker of left ventricular dysfunction in echocardiography and cardiac biomarkers in sick children with severe acute malnutrition

“… 4 In our study we observed that mean (SD) values of EF, fractional shortening (FS) were in normal range, while myocardial performance index (MPI) was abnormal in all children. Similar results were reported by Meena et al, 5 Bebars et al 6 and Akdeniz et al, 7 whereas the median (IQR) values of MPI in normal range, but individual analysis of MPI reveals that 26/88 (29.5%) of children showed abnormal values in a study by Brent et al. 8 This variability in results might be due to difference in severity of phenotypes of SAM and different grade of severity of electrolyte imbalance or trace element deficiency which affect cardiac functions.…”