Cardiac abnormalities identified with echocardiography in anorexia nervosa: systematic review and meta-analysis

Abstract

Background Anorexia nervosa affects most organ systems, with 80% suffering from cardiovascular complications. Aims To define echocardiographic abnormalities in anorexia nervosa through systematic review and meta-analysis. Method Two reviewers independently assessed eligibility of publications from Medline, EMBASE and Cochrane Database of Systematic Reviews registries. Studies were included if anorexia nervosa was the primary eating disorder and the main clinical association in described cardiac abnormalities. Data was extracted in duplicate and quality-assessed with a modified Newcastle–Ottawa scale. For continuous outcomes we calculated mean and standardised mean difference (SMD), and corresponding 95% confidence interval. For dichotomous outcomes we calculated proportion and corresponding 95% confidence interval. For qualitative data we summarised the studies. Results We identified 23 eligible studies totalling 960 patients, with a mean age of 17 years and mean body mass index of 15.2 kg/m2. Fourteen studies (469 participants) reported data suitable for meta-analysis. Cardiac abnormalities seen in anorexia nervosa compared with healthy controls were reduced left ventricular mass (SMD 1.82, 95% CI 1.32–2.31, P < 0.001), reduced cardiac output (SMD 1.92, 95% CI 1.38–2.45, P < 0.001), increased E/A ratio (SMD −1.10, 95% CI −1.67 to −0.54, P < 0.001), and increased incidence of pericardial effusions (25% of patients, P < 0.01, 95% CI 17–34%, I2 = 80%). Trends toward improvement were seen with weight restoration. Conclusions Patients with anorexia nervosa have structural and functional cardiac changes, identifiable with echocardiography. Further work should determine whether echocardiography can help stratify severity and guide safe patient location, management and effectiveness of nutritional rehabilitation.

Impact of BMI z-score On Left Ventricular Mechanics in a Pediatric Population

“…We found a positive correlation between the BMI z-score and the LV mass. These results are in agreement with current knowledge on the cardiac remodeling induced by WD, namely a decrease in measurements in AN [3,25,26] and conversely an increase in OB [2,6]. These morphological adaptations are linked not only to the nutritional state itself but also to the load conditions [27], which vary with BMI, as demonstrated in our study by positive correlation between BMI z-score and clinical variables of HR and BP.…”

To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol

“…Finally, 22–35% of adolescents with AN have a degree of pericardial effusion, the vast majority remaining asymptomatic [ 37 ]. All these complications are reversible with nutritional rehabilitation [ 38 ]. This suggests that a routine cardiac ultrasound screening for all patients admitted with severe AN is not indicated as rarely will it affect the natural trajectory of these complications or the patient’s management plan.…”

A Comprehensive Review of Complications and New Findings Associated with Anorexia Nervosa

“…Whether this portends a higher risk of cardiovascular disease, or if it is reversed with weight restoration, remains to be seen. A meta-analysis of echocardiographic findings in patients with AN revealed a reduction in left ventricular mass, a reduction in cardiac output, diastolic dysfunction, and an association with mitral valve prolapse and pericardial effusion, with a trend toward improvement with weight restoration [92]. Left ventricular mass was increased in hyperactive patients with AN as compared with non-hyperactive patients with AN but was still significantly lower than in the healthy controls [93].…”