Cardiac Atrophy and Ventricular Function in Infants with Severe Protein Calorie Malnutrition (Kwashiorkor Disease)

Shoukry, Ibrahim; Shoukry, Ahmed Safwat; Ibrahim, M. Mohsen; Fahmy, Nahed; Madkour, M. Aziz; Said, Galal El

doi:10.1007/978-1-4613-8598-1_310

Cited by 11 publications

(9 citation statements)

References 2 publications

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“…Bergman et al (1988) stated that, although primary myocardial dysfunction is not present in KWO, there is a decreased myocardial mass, which may lead to an inability of the ventricles to respond to increases in ventricular preload. Moreover, Shoukry et al (1986) reported similar findings to ours, namely the reduced myocardial mass with preserved LV function in PEM.…”

Section: Discussionsupporting

confidence: 88%

“…On the contrary, Shoukry et al (1986) reported that infants with KWO have evidence of impairment of the LV function evidenced by the reduction of the fractional shortening compared with age-matched healthy controls. Also, Phornphatkul et al (1994) concluded that the children with primary third-degree malnutrition not only have cardiac wasting, but also inherent ventricular dysfunction as the result of severe malnutrition that responds to nutritional therapy.…”

Section: Discussionmentioning

confidence: 94%

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Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery

et al. 2005

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Background and objectives: The pathogenesis of different malnutrition diseases was suggested to affect the heart. This study was designed to detect cardiac affection in protein energy malnutrition (PEM) patients, whether clinically or by electrocardiogram (ECG) and echocardiogram, and to assess the value of the cardiac marker troponin I in patients at risk of myocardial injury with special emphasis on the effect of nutritional rehabilitation. Patients and methods: The present study was carried out on 30 PEM infants (16 nonedematous -14 edematous) and 10 apparently healthy age and sex-matched infants acting as the control group. All studied infants were subjected to full history taking laying stress on dietetic history, thorough clinical and anthropometric measurements. Echocardiography and ECG were also performed. Laboratory investigations were performed including complete blood count, CRP, total proteins, albumin, liver and kidney functions as well as estimation of troponin-I in blood by immulite. Following initial evaluation, all malnourished infants were subjected to nutritional rehabilitation program for approximately 8 weeks, after which the patients were reevaluated using the same preinterventional parameters. Results: The results of the present study demonstrated that electrical properties of myocardium assessed by ECG showed significant decrease of R wave and QTc interval in patients compared to controls with significant improvement after nutritional rehabilitation. Echocardigraphic changes showed that cardiac mass index was significantly lower in both groups of malnourished cases compared to the controls with significant increase after nutritional rehabilitation. The study showed that the parameters of left ventricular (LV) systolic function which are the ejection fraction, fractional shortening and velocity of circumferential fiber shortening were not significantly reduced in patients compared to the controls. The diastolic function also showed no significant difference in the E wave/A wave (e/a) ratio between patients and controls. However, the systolic time interval showed significantly higher LV pre-ejection index in patients in comparison to controls. Edematous and nonedematous cases did not show any significant differences in ECG and echocardigraphic data before or after nutritional rehabilitation. The hearts of two severely affected patients uniquely demonstrated marked decrease of LV end diastolic diameter (LEVDd) together with the detection of troponin-I in their sera. Conclusion: We can conclude that malnutrition, regardless of its type, has a definite effect on cardiac volume, muscle mass, as well as the electrical properties of the myocardium. The systolic functions of the heart are affected more than the diastolic functions and this affection becomes manifest only in severe cases and may constitute a bad prognostic parameter thus necessitating more intense management and strict follow-up of such cases.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 94%

Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery

et al. 2005

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“…4,9 Moreover, Shoukry et al reported similar findings to present study, namely the reduced myocardial mass in Malnutrition. 14 Phornphatkul C et al observed decrease cardiac mass among children with SAM during admission to the hospital and recovered subsequent to nutritional therapy. 5 All children had echocardiographic and Doppler measurements indicative of impaired ventricular function which significantly improved during the course of hospitalization, as evidence in part by the change in fractional shortening, (P=0.015) mean velocity of circumferential fibre shortening, (P=0.038) and systolic time interval (P=0.03).…”

Section: Discussionmentioning

confidence: 99%

What affect heart in SAM: structure or function

Sharma

Gaur

Agrawal

2017

Int J Contemp Pediatr

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Background: Objective of present study was to assess structural and functional cardiac changes in children with severe acute malnutrition between the age of 6 month to 59 months. Setting: The study conducted in Department of paediatrics, Kamla Raja Hospital, Gajra Raja Medical College, Gwalior. A prospective case control study. Participants: 100 cases and 100 controls enrolled based on the selection criteria, Control group was selected from patient came in Out Patient Department. Children from 6 months to 59 months of age with weight for height ranging <-3SD and/or Mid Upper Arm Circumference (MUAC) <11.5 cm and/or edematous malnutrition and/or visible severe wasting). Selection of cases and control were done through random sampling method.Methods: All enrolled admitted children were stabilised after admission as per WHO protocol of management. After that they undergone echocardiographic and electrocardiographic evaluation and data were collected and Analysed.Results: In this study, study group show decrease in dimension of heart i.e. IVSd (p-value-0.02413), LVEDd (p-value-0.0000017), PLVWd (p-value-0.01493), LVEDs (p-value-0.0000263), PLVWs (p-value-0.0000254) more affected during diastole than systole, increased HR (p-value-0.0044), shorten PR intervals (p-value-0.0001) and shorten P wave(p-value-0.000385), QT (p-value-0.044) and QTc (p-value-0.00968) as compared to control group. Pericardial effusion found in 16 cases in study group (8 mild and 8 trace).Conclusions: Early evaluation of cardiac function in malnourished child will significantly affect the management of Severe Acute Malnutrition to prevent deaths from Severe Acute Malnutrition.

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“…In our study we found that mean haemoglobin (9.43±2.10 gm%) and calcium (0.99±0.18 mmol/l) level in SAM children were significantly lower as compared to mean Hb (11.15±1.26 gm%) and calcium (1.05±0.10 mmol/L)in normal children (p<0.05) ( (Table-2). We also observed that functional cardiac changes in form of ejection fraction, Fractional shortening and stroke volume significantly lower in SAM children as compared to normal children (Table-3 Faddan et al/Egypt/2010 [6] 7 [12] 100 20 Similar result were found in previous study by Nagla Hassan Abu Faddan et al (2010), [6] They reported mean interventricular septal diameter, posterior wall diameter, left ventricular mass to be reduced i n malnourished patients(45 cases) in comparison to apparently healthy controls (25 controls), Fractional shortening and ejection fraction were also reduced in malnourished patients, while end systolic diameter (ESD)and end diastolic diameter (EED) were not significantly different among both groups, Shoukry et al (1986), [13] detected that left ventricular mass was significantly reduced in kwashiorkor as compared to healthy children in same age. And they also reported impairment of left ventricular function as evidenced by reduction fractional shortening and ejection fraction in kwashiorkor.…”

Section: R E S U L T Smentioning

confidence: 99%

To Study Structural and Functional Cardiac Changes in Children with Severe Acute Malnutrition

Prajapati¹,

Singh²

2019

jemds

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BACKGROUND Severe acute malnutrition (SAM) is one of the most important health problems affecting hundreds of millions of children in the world. Malnourished children suffer several alterations in body composition, with loss of heart and skeletal muscle mass, complicated by electrolyte abnormalities and mineral or vitamin deficiencies that could produce cardiac abnormalities. The present study was undertaken to compare cardiac structural and functional parameters in severe malnutrition and age matched control in Indian children. We wanted to assess the structural and functional cardiac changes in children with severe acute malnutrition. METHODS This is a case control study conducted in paediatric cardiology clinic and severe malnutrition treatment unit (SMTU) of department of paediatrics SSMC associated Gandhi Memorial Hospital, Rewa, M. P. 50 SAM children admitted in SMTU and 50 normal children aged 6 months to 60 months were included in the study. Structural and functional cardiac parameters in SAM children (Cases) were compared with those of normal children (Controls) on the basis of Echocardiography. For structural cardiac changes, interventricular septum thickness (IVS), left ventricular internal diameter (LVID), left ventricular posterior wall thickness (LVPW) and left ventricular mass (LVM) were measured. For functional cardiac changes ejection fraction (EF), fractional shortening (FS) and stroke volume (SV) were measured. RESULTS In the present study, all structural parameters viz the 'IVSs' during systole, IVSd during diastole, LVPWs during systole, LVPWd during diastole, and LVM, all parameters were significantly reduced in SAM children as compared to normal children and functional changes in the form of ejection fraction, fractional shortening and stroke volume (p<0.0001) were also significantly reduced. CONCLUSIONS There was significant reduction in structural (Thickness of IVS, LVPW and LVM) and functional parameters (EF, FS and SV) in SAM children as compared to normal children.

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Cardiac Atrophy and Ventricular Function in Infants with Severe Protein Calorie Malnutrition (Kwashiorkor Disease)

Cited by 11 publications

References 2 publications

Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery

Structural and functional affection of the heart in protein energy malnutrition patients on admission and after nutritional recovery

What affect heart in SAM: structure or function

To Study Structural and Functional Cardiac Changes in Children with Severe Acute Malnutrition

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