The Role of Cardiac Magnetic Resonance Imaging in Severe Anorexia Nervosa

Abstract

Objective Anorexia nervosa (AN) patients are at an increased risk of developing cardiac complications including bradyarrhythmias, systolic dysfunction, pericardial effusions, and sudden cardiac death. Although previous echocardiographic studies in AN patients have demonstrated a reduction in overall left ventricular (LV) mass, systolic dysfunction, and silent pericardial effusions, little is known about the role of cardiac magnetic resonance imaging (CMR) in assessing this patient population. The objective of this study was to assess cardiac indices and the presence of myocardial fibrosis in AN patients. Methods Between 2014 and 2015, a cross-sectional pilot study of 16 female patients who met the Diagnostic and Statistics Manual of Mental Disorders, fifth edition (DSM-5) criteria for AN was conducted at a single tertiary care center. Baseline characteristics including age, weight, food restriction behavior, over-exercise, self-induced vomiting, and laxative abuse were collected in the study population. Electrocardiography, transthoracic echocardiography (TTE), and CMR were performed. Results The mean age was 17 years (range: 13-22 years). There were no conduction abnormalities as the average PR interval was 152 ms (range: 130-190 ms) and QTc was 413 ms (range: 360-450 ms). Using TTE, the left ventricular ejection fraction (LVEF) was 54 ± 4% with a lower LV mass/body surface area (BSA) of 56 ± 7g/m 2 in AN patients as compared to controls. Using CMR, both the mean LVEF of 52 ± 9% and LV mass/BSA of 45 ± 4g/m 2 were lower in AN patients as compared to controls. Using CMR, both right ventricular ejection fraction (RVEF) of 50 ± 10% and a right ventricular (RV) mass/BSA of 18 ± 3g/m 2 were smaller in AN patients as compared to controls. There was no evidence of late gadolinium enhancement (LGE) in the study population. Conclusions Young patients with AN have lower cardiac mass and volumes with no evidence of myocardial fibrosis.

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

“…A more recent study did not find evidence of LGE on CMRI in patients with AN. However, the majority of AN patients had recovered weight at the time of CMRI in the study [96]. More CMRI studies in patients with AN are warranted to better understand the prevalence of myocardial fibrosis and the clinical significance.…”