1
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Kurisu K, Yamazaki T, Yoshiuchi K. Predicting extremely low body weight from 12-lead electrocardiograms using a deep neural network. Sci Rep 2024; 14:4696. [PMID: 38409450 PMCID: PMC10897430 DOI: 10.1038/s41598-024-55453-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/23/2024] [Indexed: 02/28/2024] Open
Abstract
Previous studies have successfully predicted overweight status by applying deep learning to 12-lead electrocardiogram (ECG); however, models for predicting underweight status remain unexplored. Here, we assessed the feasibility of deep learning in predicting extremely low body weight using 12-lead ECGs, thereby investigating the prediction rationale for highlighting the parts of ECGs that are associated with extremely low body weight. Using records of inpatients predominantly with anorexia nervosa, we trained a convolutional neural network (CNN) that inputs a 12-lead ECG and outputs a binary prediction of whether body mass index is ≤ 12.6 kg/m2. This threshold was identified in a previous study as the optimal cutoff point for predicting the onset of refeeding syndrome. The CNN model achieved an area under the receiver operating characteristic curve of 0.807 (95% confidence interval, 0.745-0.869) on the test dataset. The gradient-weighted class activation map showed that the model focused on QRS waves. A negative correlation with the prediction scores was observed for QRS voltage. These results suggest that deep learning is feasible for predicting extremely low body weight using 12-lead ECGs, and several ECG features, such as lower QRS voltage, may be associated with extremely low body weight in patients with anorexia nervosa.
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Affiliation(s)
- Ken Kurisu
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tadahiro Yamazaki
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiro Yoshiuchi
- Department of Stress Sciences and Psychosomatic Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
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2
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Dedoni S, Scherma M, Camoglio C, Siddi C, Fratta W, Fadda P. Anaplastic Lymphoma Kinase Receptor: Possible Involvement in Anorexia Nervosa. Nutrients 2023; 15:2205. [PMID: 37432348 DOI: 10.3390/nu15092205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/02/2023] [Accepted: 05/04/2023] [Indexed: 07/12/2023] Open
Abstract
The pathophysiology of Anorexia Nervosa (AN) has not been fully elucidated. Anaplastic lymphoma kinase (ALK) receptor is a protein-tyrosine kinase mainly known as a key oncogenic driver. Recently, a genetic deletion of ALK in mice has been found to increase energy expenditure and confers resistance to obesity in these animals, suggesting its role in the regulation of thinness. Here, we investigated the expression of ALK and the downstream intracellular pathways in female rats subjected to the activity-based anorexia (ABA) model, which reproduces important features of human AN. In the hypothalamic lysates of ABA rats, we found a reduction in ALK receptor expression, a downregulation of Akt phosphorylation, and no change in the extracellular signal-regulated protein kinases 1 and 2 (ERK1/2) phosphorylation. After the recovery from body weight loss, ALK receptor expression returned to the control baseline values, while it was again suppressed during a second cycle of ABA induction. Overall, this evidence suggests a possible involvement of the ALK receptor in the pathophysiology of AN, that may be implicated in its stabilization, resistance, and/or its exacerbation.
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Affiliation(s)
- Simona Dedoni
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Science, University of Cagliari, 09124 Cagliari, Italy
| | - Maria Scherma
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Science, University of Cagliari, 09124 Cagliari, Italy
| | - Chiara Camoglio
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Science, University of Cagliari, 09124 Cagliari, Italy
| | - Carlotta Siddi
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Science, University of Cagliari, 09124 Cagliari, Italy
| | - Walter Fratta
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Science, University of Cagliari, 09124 Cagliari, Italy
| | - Paola Fadda
- Section of Neuroscience and Clinical Pharmacology, Department of Biomedical Science, University of Cagliari, 09124 Cagliari, Italy
- Neuroscience Institute, Section of Cagliari, National Research Council of Italy (CNR), 09042 Cagliari, Italy
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3
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Friars D, Walsh O, McNicholas F. Assessment and management of cardiovascular complications in eating disorders. J Eat Disord 2023; 11:13. [PMID: 36717950 PMCID: PMC9886215 DOI: 10.1186/s40337-022-00724-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/18/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are serious conditions predominantly affecting adolescents and young adults (AYAs) and pose a considerable threat to their health and wellbeing. Much of this increased morbidity and mortality is linked to medical compromise, especially cardiovascular abnormalities. Rates of presentation to both community and inpatient medical settings have increased in all age groups following the Covid-19 pandemic and subsequent "lockdowns", with patients presentations being more medically compromised compared to previous years. This has implications for clinicians with regard to the performance of competent cardiovascular assessments and management of findings. AIMS This paper is a practical resource for clinicians working with AYAs in whom EDs may present. It will provide a brief summary of the physiological context in which cardiovascular complications develop, systematically outline these complications and suggest a pragmatic approach to their clinical evaluation. METHODS Relevant literature, guidelines and academic texts were critically reviewed. Conclusions were extracted and verified by a Child and Adolescent Psychiatrist and Adolescent Paediatrician, with suitable expertise in this clinical cohort. CONCLUSIONS The cardiovascular complications in EDs are primarily linked to malnutrition, and patients presenting with Anorexia Nervosa are most often at greatest risk of structural and functional cardiac abnormalities, including aberrations of heart rate and rhythm, haemodynamic changes and peripheral vascular abnormalities. Other cardiovascular abnormalities are secondary to electrolyte imbalances, as seen in patients with Bulimia Nervosa. More recently defined EDs including Avoidant/Restrictive Food Intake Disorder and Binge Eating Disorder are also likely associated with distinct cardiovascular complications though further research is required to clarify their nature and severity. Most cardiovascular abnormalities are fully reversible with nutritional restoration, and normalisation of eating behaviours, including the cessation of purging, though rare cases are linked to cardiac deaths. A detailed clinical enquiry accompanied by a thorough physical examination is imperative to ensure the medical safety of AYAs with EDs, and should be supported by an electrocardiogram and laboratory investigations. Consideration of cardiovascular issues, along with effective collaboration with acute medical teams allows community clinicians identify those at highest risk and minimise adverse outcomes in this cohort.
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Affiliation(s)
- Dara Friars
- Department of Psychiatry, School of Medicine, University College Dublin, Dublin, Ireland. .,, Mount Pleasant, Australia.
| | - Orla Walsh
- Department of Paediatrics, Children's Health Ireland (CHI), Temple Street University Hospital, Dublin, Ireland
| | - Fiona McNicholas
- Department of Psychiatry, School of Medicine, University College Dublin, Dublin, Ireland.,Lucena Child and Adolescent Mental Health Service (CAMHS), Dublin, Ireland.,Department of Psychiatry, Children's Health Ireland (CHI), Crumlin, Ireland
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4
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Spina G, Clemente A, Roversi M, Marchili MR, Silvestri P, Mascolo C, Zanna V, Diamanti A, Reale A, Villani A, Raucci U, Ammirati A. Early echocardiographic evaluation of children admitted to the emergency department for anorexia nervosa during the COVID-19 pandemic. Eat Weight Disord 2022; 27:3409-3417. [PMID: 36053460 PMCID: PMC9438386 DOI: 10.1007/s40519-022-01474-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/21/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Anorexia nervosa (AN) is the most frequent eating disorder (ED), whose cardiac complications may have life-threatening consequences for both the physical and psychological health of affected children. In this study, we reported and analysed the echocardiographic anomalies found in pediatric patients diagnosed with AN. METHODS We reported the demographic and clinical characteristics of children aged 8 to 18 years, who were diagnosed with AN and underwent a complete cardiological evaluation at the Emergency Department of the Bambino Gesù Children's Hospital, IRCCS, Rome between the 1st January 2021 and the 30th June 2021. Furthermore, we compared the patients according to the presence of pericardial effusion and a BMI (body mass index) cut-off 14.5 kg/m2. RESULTS Forty-nine patients were included in the study. The mean age was 15.1 years. Most patients were female (89.8%). The mean length of hospitalization was 18 days. The mean BMI at admission was 14.8 kg/m2, with a median weight loss of 9 kg in the last year. Eleven patients (22.4%) presented with cardiovascular signs or symptoms at admission. Most patients had pericardial effusion on heart ultrasound, with a mean thickness of 6 mm (SD ± 4). The LV (left ventricle) thickness over age was significantly higher in patients with pericardial effusion, with a Z score of -2.0 vs -1.4 (p = 0.014). The administration of psychiatric drugs was significantly more frequent in patients with a lower BMI (37.5% vs 12%, p = 0.038). CONCLUSION Our study suggests that a non-urgent baseline echocardiographic evaluation with focus on left-ventricular wall thickness and mass in children with anorexia nervosa is advisable. LEVEL III Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- Giulia Spina
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Anna Clemente
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Roversi
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Maria Rosaria Marchili
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paola Silvestri
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Cristina Mascolo
- University Hospital Pediatric Department, Bambino Gesù Children's Hospital, IRCCS, Tor Vergata University, Rome, Italy
| | - Valeria Zanna
- Anorexia Nervosa and Eating Disorders Unit, Child Neuropsychiatry, Department of Neuroscience, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Antonella Diamanti
- Hepatology, Gastroenterology and Nutrition Unit, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
| | - Antonino Reale
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
- Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Antonio Ammirati
- Consultant Cardiologist at Pediatric Emergency Unit, Department of Emergency, Acceptance and General Pediatrics, Pediatric Emergency Department, Bambino Gesù Children's Hospital, Rome, Italy
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5
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Santangelo G, Bursi F, Toriello F, Tamagni ME, Fior G, Massironi L, Bertelli S, Fanin A, Gambini O, Carugo S, Benetti A. Echocardiographic changes in anorexia nervosa: a pathophysiological adaptation or a disease? Intern Emerg Med 2022; 17:777-787. [PMID: 34677790 DOI: 10.1007/s11739-021-02871-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/12/2021] [Indexed: 11/25/2022]
Abstract
Anorexia Nervosa is one of the most common form of eating disorders. Cardiac involvement occurs in approximately 80% of patients. Few reports focused on the association between body weight fluctuations and echocardiographic abnormalities, considering linear measurements. We describe echocardiographic and clinical features among male and female patients with anorexia nervosa and the effect of weight gain on these parameters. We performed a single center, retrospective study of patients followed at a dedicated multidisciplinary Unit. The study population consisted of 81 patients, mean age 25 ± 11 years, 94% female. Median body mass index was 14.4 kg/m2 (25th-75th percentile 12.7-15.6 kg/m2). Patients with body mass index below the median value had more often pericardial effusion, smaller left ventricular mass and left ventricular end-diastolic volume and thinner interventricular septum. However, when indexed to body surface area, left ventricular mass and volumes were within the normal range in 90% of population. Patients with pericardial effusion showed mitral valve abnormalities and lower values of white blood cells and platelets, although within normal limits. Presence of pericardial effusion was not related to inflammatory parameters or low plasma protein levels. In 39 patients who displayed weight gain during a median follow-up of 189 days (25th-75th percentile 47-471), increased left ventricular mass, interventricular septum thickness, white blood cells and platelet count and decreased pericardial effusion were observed. Patients with anorexia nervosa have a specific echocardiographic pattern which seems to be proportional to the body size, suggesting a pathophysiological adaptation to the lack of substrates.
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Affiliation(s)
- G Santangelo
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy.
| | - F Bursi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - F Toriello
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - M E Tamagni
- Division of Internal Medicine, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - G Fior
- Division of Psychiatry, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - L Massironi
- Division of Cardiology, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - S Bertelli
- Division of Psychiatry, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - A Fanin
- Division of Internal Medicine, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - O Gambini
- Division of Psychiatry, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - S Carugo
- Division of Cardiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - A Benetti
- Division of Internal Medicine, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
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6
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Corsini I, Leardini D, Carfagnini F, Pession A, Lanari M. Massive Pericardial Effusion in a 14-Year-Old Girl with Mild Fatigue and Neck Pain. Pediatr Rep 2022; 14:8-12. [PMID: 35076583 PMCID: PMC8788428 DOI: 10.3390/pediatric14010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/14/2021] [Accepted: 12/21/2021] [Indexed: 02/01/2023] Open
Abstract
Pericardial effusion is rare in pediatric patients and is characterized by a variable clinical presentation. Mild symptoms may be present despite severe effusion. We here report the case of a patient with massive pericardial effusion with mild clinical presentation. Our case points out the need not to exclude this diagnosis in patients with mild general impairment. This clinical suspicion can be lifesaving.
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Affiliation(s)
- Ilaria Corsini
- Unit of Pediatrics Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.C.); (M.L.)
| | - Davide Leardini
- Specialty School of Pediatrics, University of Bologna, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-214-4665
| | - Filomena Carfagnini
- Unit of Pediatric Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Andrea Pession
- Unit of Pediatrics, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Marcello Lanari
- Unit of Pediatrics Emergency, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (I.C.); (M.L.)
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7
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Rynkiewicz A, Dembiński Ł, Koletzko B, Michaud PA, Hadjipanayis A, Grossman Z, Korslund K, King BH, Treasure J, Peregud-Pogorzelski J, Del Torso S, Valiulis A, Mazur A. Adolescents With Eating Disorders in Pediatric Practice - The European Academy of Paediatrics Recommendations. Front Pediatr 2022; 10:806399. [PMID: 35558369 PMCID: PMC9086960 DOI: 10.3389/fped.2022.806399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 03/23/2022] [Indexed: 11/13/2022] Open
Abstract
In the face of the growing number of adolescents suffering from eating disorders (EDs) and access to psychiatric care limited by the epidemiological and demographic situation, the primary care pediatrician's role in diagnosing and treating EDs is growing. The European Academy of Paediatrics (EAP) decided to summarize knowledge about EDs and formulate recommendations to support European pediatricians and improve care for adolescents with EDs.
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Affiliation(s)
- Agnieszka Rynkiewicz
- Department of Psychiatry, College of Medical Sciences, Institute of Medical Sciences, University of Rzeszow, Rzeszow, Poland.,Center for Diagnosis, Therapy and Education SPECTRUM ASC-MED, Gdańsk, Poland
| | - Łukasz Dembiński
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
| | - Berthold Koletzko
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Paediatrics, Dr. von Hauner Children's Hospital, University of Munich Medical Centre, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Pierre-André Michaud
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Faculté de Biologie et de Médecine, Université de Lausanne, Lausanne, Switzerland
| | - Adamos Hadjipanayis
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,School of Medicine, European University Cyprus, Nicosia, Cyprus.,Department of Paediatrics, Larnaca General Hospital, Larnaca, Cyprus
| | - Zachi Grossman
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Adelson School of Medicine, Ariel University, Ariel, Israel.,Maccabi Health Services, Tel Aviv, Israel
| | | | - Bryan H King
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, United States
| | - Janet Treasure
- Eating Disorder Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Jarosław Peregud-Pogorzelski
- Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, Szczecin, Poland.,Polish Society of Paediatrics, Warsaw, Poland
| | - Stefano Del Torso
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,ChildCare WorldWide-CCWWItalia OdV, Padova, Italy
| | - Arunas Valiulis
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Clinic of Children's Diseases, Institute of Clinical Medicine, Vilnius University Medical Faculty, Vilnius, Lithuania.,Department of Public Health, Institute of Health Sciences, Vilnius University Medical Faculty, Vilnius, Lithuania
| | - Artur Mazur
- The European Academy of Paediatrics (EAP), Brussels, Belgium.,Department of Paediatrics, College of Medical Sciences, Institute of Medical Sciences, University of Rzeszow, Rzeszow, Poland
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8
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Smythe J, Colebourn C, Prisco L, Petrinic T, Leeson P. Cardiac abnormalities identified with echocardiography in anorexia nervosa: systematic review and meta-analysis. Br J Psychiatry 2021; 219:477-486. [PMID: 32026793 DOI: 10.1192/bjp.2020.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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.
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Affiliation(s)
- Jodie Smythe
- Consultant Intensivist and Anaesthetist, Intensive Care Unit, Royal Berkshire NHS Foundation Trust, UK
| | - Claire Colebourn
- Consultant Medical Intensivist, Adult Intensive Care Unit, Oxford University Hospitals NHS Foundation Trust, UK
| | - Lara Prisco
- Consultant Intensivist and Anaesthetist and Senior Clinical Research Fellow, Neuroanaesthesia and Neurointensive Care, Oxford University Hospitals NHS Foundation Trust; and Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Tatjana Petrinic
- Outreach Librarian, Bodleian Healthcare Libraries, University of Oxford, Oxford University Hospitals NHS Foundation Trust, UK
| | - Paul Leeson
- Professor of Cardiovascular Medicine, Cardiovascular Clinical Research Facility, Oxford University Hospitals NHS Foundation Trust, UK
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9
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Abstract
We present a case of extreme bradycardia in an 18-year-old man, accompanied by bilateral pleural effusions, pericardial effusion, endocrine dysregulation and Horner's syndrome. Despite extensive investigations as an inpatient and multidisciplinary input, it was not until subsequent assessment by an endocrine team that it was revealed that his presentation was attributable to an eating disorder. Following dietary advice, easing of extreme exercise and continued support, the patient improved in all parameters including body mass index and he remains well. This case demonstrates the importance of a thorough personal history incorporating all aspects of social and dietary history.
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Affiliation(s)
- Elizabeth Anderson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, South Yorkshire, UK
| | - Julian Gunn
- Cardiovascular Research Unit, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK .,Department of Infection, Immunity and Cardiovascular Disease, The University of Sheffield, Sheffield, UK
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10
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Brinkmann F, Hanusch B, Ballmann M, Mayorandan S, Bollenbach A, Chobanyan-Jürgens K, Jansen K, Schmidt-Choudhury A, Derichs N, Tsikas D, Lücke T. Activated L-Arginine/Nitric Oxide Pathway in Pediatric Cystic Fibrosis and Its Association with Pancreatic Insufficiency, Liver Involvement and Nourishment: An Overview and New Results. J Clin Med 2020; 9:jcm9062012. [PMID: 32604946 PMCID: PMC7356307 DOI: 10.3390/jcm9062012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 02/07/2023] Open
Abstract
Cystic fibrosis (CF; OMIM 219700) is a rare genetic disorder caused by a chloride channel defect, resulting in lung disease, pancreas insufficiency and liver impairment. Altered L-arginine (Arg)/nitric oxide (NO) metabolism has been observed in CF patients’ lungs and in connection with malnutrition. The aim of the present study was to investigate markers of the Arg/NO pathway in the plasma and urine of CF patients and to identify possible risk factors, especially associated with malnutrition. We measured the major NO metabolites nitrite and nitrate, Arg, a semi-essential amino acid and NO precursor, the NO synthesis inhibitor asymmetric dimethylarginine (ADMA) and its major urinary metabolite dimethylamine (DMA) in plasma and urine samples of 70 pediatric CF patients and 78 age-matched healthy controls. Biomarkers were determined by gas chromatography–mass spectrometry and high-performance liquid chromatography. We observed higher plasma Arg (90.3 vs. 75.6 µM, p < 0.0001), ADMA (0.62 vs. 0.57 µM, p = 0.03), Arg/ADMA ratio (148 vs. 135, p = 0.01), nitrite (2.07 vs. 1.95 µM, p = 0.03) and nitrate (43.3 vs. 33.1 µM, p < 0.001) concentrations, as well as higher urinary DMA (57.9 vs. 40.7 µM/mM creatinine, p < 0.001) and nitrate (159 vs. 115 µM/mM creatinine, p = 0.001) excretion rates in the CF patients compared to healthy controls. CF patients with pancreatic sufficiency showed plasma concentrations of the biomarkers comparable to those of healthy controls. Malnourished CF patients had lower Arg/ADMA ratios (p = 0.02), indicating a higher NO synthesis capacity in sufficiently nourished CF patients. We conclude that NO production, protein-arginine dimethylation, and ADMA metabolism is increased in pediatric CF patients. Pancreas and liver function influence Arg/NO metabolism. Good nutritional status is associated with higher NO synthesis capacity and lower protein-arginine dimethylation.
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Affiliation(s)
- Folke Brinkmann
- University Children’s Hospital, Ruhr University, 44791 Bochum, Germany; (F.B.); (M.B.); (K.J.); (A.S.-C.); (T.L.)
| | - Beatrice Hanusch
- University Children’s Hospital, Ruhr University, 44791 Bochum, Germany; (F.B.); (M.B.); (K.J.); (A.S.-C.); (T.L.)
- Correspondence: ; Tel.: +49-234-5092615
| | - Manfred Ballmann
- University Children’s Hospital, Ruhr University, 44791 Bochum, Germany; (F.B.); (M.B.); (K.J.); (A.S.-C.); (T.L.)
- Paediatric Clinic, University Medicine Rostock, 18057 Rostock, Germany
| | - Sebene Mayorandan
- Department of Paediatrics, Hannover Medical School, 30623 Hannover, Germany; (S.M.); (K.C.-J.); (N.D.)
- Department of Paediatrics, University Clinic Münster, 48149 Münster, Germany
| | - Alexander Bollenbach
- Institute of Toxicology, Core Unit Proteomics, Hannover Medical School, 30623 Hannover, Germany; (A.B.); (D.T.)
| | - Kristine Chobanyan-Jürgens
- Department of Paediatrics, Hannover Medical School, 30623 Hannover, Germany; (S.M.); (K.C.-J.); (N.D.)
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Department of General Pediatrics, Neuropediatrics, Metabolism, Gastroenterology, Nephrology, Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Pediatric Clinical-Pharmacological Trial Center (paedKliPS), Center for Pediatric and Adolescent Medicine, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Kathrin Jansen
- University Children’s Hospital, Ruhr University, 44791 Bochum, Germany; (F.B.); (M.B.); (K.J.); (A.S.-C.); (T.L.)
| | - Anjona Schmidt-Choudhury
- University Children’s Hospital, Ruhr University, 44791 Bochum, Germany; (F.B.); (M.B.); (K.J.); (A.S.-C.); (T.L.)
| | - Nico Derichs
- Department of Paediatrics, Hannover Medical School, 30623 Hannover, Germany; (S.M.); (K.C.-J.); (N.D.)
- KinderPneumologieDerichs, Pediatric Pneumology and Allergology, CFTR & Pulmonary Research Center, 30173 Hannover, Germany
| | - Dimitrios Tsikas
- Institute of Toxicology, Core Unit Proteomics, Hannover Medical School, 30623 Hannover, Germany; (A.B.); (D.T.)
| | - Thomas Lücke
- University Children’s Hospital, Ruhr University, 44791 Bochum, Germany; (F.B.); (M.B.); (K.J.); (A.S.-C.); (T.L.)
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Abstract
Anorexia nervosa, one of the more frequent and severe eating disorders, is a chronic psychiatric disease with potentially serious somatic consequences. This behavioral symptomatology leads to weight loss, undernutrition, and more or less severe-potentially life-threatening-somatic complications including respiratory, hepatic, digestive and cardiac features, electrolyte disturbances, endocrine and bone impairment, immunodepression, and related opportunistic infections. In this review, the authors report an overview of cardiac diseases in this disease.
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Affiliation(s)
- Abdallah Fayssoil
- Nutrition Unit, Raymond Poincaré Hospital, APHP, boulevard Raymond Poincaré, 92380, Garches, France. .,Service de neurologie, Institut de Myologie, boulevard de l'hôpital, 75013, Paris, France. .,Pitié Salpetrière Hospital, APHP, boulevard de l'hôpital, 75013, Paris, France.
| | - Jean Claude Melchior
- Nutrition Unit, Raymond Poincaré Hospital, APHP, boulevard Raymond Poincaré, 92380, Garches, France
| | - Mouna Hanachi
- Nutrition Unit, Raymond Poincaré Hospital, APHP, boulevard Raymond Poincaré, 92380, Garches, France
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12
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Scharner S, Stengel A. Alterations of brain structure and functions in anorexia nervosa. CLINICAL NUTRITION EXPERIMENTAL 2019. [DOI: 10.1016/j.yclnex.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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13
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Anorexia nervosa and heart disease: a systematic review. Eat Weight Disord 2019; 24:199-207. [PMID: 30173377 DOI: 10.1007/s40519-018-0567-1] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/17/2018] [Indexed: 01/12/2023] Open
Abstract
Anorexia nervosa (AN) is an eating disorder that most frequently afflicts females in adolescence. In these subjects, cardiovascular complications are the main cause of morbidity and mortality. Aim of this review is to analyze the hemodynamic, pro-arrhythmic and structural changes occurring during all phases of this illness, including re-feeding. A systematic literature search was performed on studies in the MEDLINE database, from its inception until September 2017, with PUBMED interface focusing on AN and cardiovascular disease. This review demonstrated that the most common cardiac abnormalities in AN are bradycardia and QT interval prolongation, which may occasionally degenerate into ventricular arrhythmias such as Torsades des Pointes or ventricular fibrillation. As these arrhythmias may be the substrate of sudden cardiac death (SCD), they require cardiac monitoring in hospital. In addition, reduced cardiac mass, with smaller volumes and decreased cardiac output, may be found. Furthermore, mitral prolapse and a mild pericardial effusion may occur, the latter due to protein deficiency and low levels of thyroid hormone. In anorectic patients, some cases of hypercholesterolemia may be present; however, conclusive evidence that AN is an atherogenic condition is still lacking, although a few cases of myocardial infarction have been reported. Finally, refeeding syndrome (RFS), which occurs during the first days of refeeding, may engender a critically increased risk of acute, life-threatening cardiac complications.
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14
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Chu K, Asselin CY, Buffo I, Lane M, Ludwig L, Jassal DS, Schantz D. The Role of Cardiac Magnetic Resonance Imaging in Severe Anorexia Nervosa. Cureus 2019; 11:e4229. [PMID: 31123651 PMCID: PMC6510561 DOI: 10.7759/cureus.4229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
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/m2 in AN patients as compared to controls. Using CMR, both the mean LVEF of 52 ± 9% and LV mass/BSA of 45 ± 4g/m2 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/m2 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.
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Affiliation(s)
- Karen Chu
- Internal Medicine, University of Manitoba, Winnipeg, CAN
| | | | - Ilan Buffo
- Pediatrics, University of Manitoba, Winnipeg, CAN
| | - Margo Lane
- Psychiatry, University of Manitoba, Winnipeg, CAN
| | - Louis Ludwig
- Psychiatry, University of Manitoba, Winnipeg, CAN
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15
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Excessive physical activity in young girls with restrictive-type anorexia nervosa: its role on cardiac structure and performance. Eat Weight Disord 2018; 23:653-663. [PMID: 29058271 DOI: 10.1007/s40519-017-0447-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 09/25/2017] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The aim of this study was to investigate the influence of hyperactivity on left ventricular mass (LVM) in Anorexia Nervosa restricting-type (AN-R) and the correlation between LVM and auxologic parameters/circulating hormones. METHODS Echocardiography was performed in 44 AN-R girls, subgrouped in 24 hyperactive (ANH+) and 20 non-hyperactive (ANH-), and in 20 controls (HC). LVM indexed to Body Surface Area (LVMi) and LVM indexed to height (LVMh) were calculated. RESULTS LVMi and LVMh were significantly lower in the AN-R subjects compared to HC. Moreover, both LVMi and LVMh were higher in the ANH+ than in the ANH-. In the HC, LVMi was higher when compared to the ANH- subjects than to the ANH+. Stepwise analysis revealed that in the ANH+ group, fT4 was the only independent predictor of LVMh, while in the ANH- group, height was the only independent predictors of LVMi. CONCLUSIONS Despite its negative influence on disease severity and outcome, hyperactivity from the standpoint of cardiac function makes the LVM of AN-R young girls more similar to HC. LEVEL OF EVIDENCE Level III, case-control study.
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16
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Gibson D, Drabkin A, Krantz MJ, Mascolo M, Rosen E, Sachs K, Welles C, Mehler PS. Critical gaps in the medical knowledge base of eating disorders. Eat Weight Disord 2018; 23:419-430. [PMID: 29681012 DOI: 10.1007/s40519-018-0503-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/22/2018] [Indexed: 12/14/2022] Open
Abstract
Eating disorders are unique in that they inherently have much medical comorbidity both as a part of restricting-type eating disorders and those characterized by purging behaviors. Over the last three decades, remarkable progress has been made in the understanding and treatment of the medical complications of eating disorders. Yet, unfortunately, there is much research that is sorely needed to bridge the gap between current medical knowledge and more effective and evidence-based medical treatment knowledge. These gaps exist in many different clinical areas including cardiology, electrolytes, gastrointestinal and bone disease. In this paper, we discuss some of the knowledge gap areas, which if bridged would help develop more effective medical intervention for this population of patients.
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Affiliation(s)
- Dennis Gibson
- ACUTE, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA
| | - Anne Drabkin
- ACUTE, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA
| | - Mori J Krantz
- Division of Cardiology, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA
| | | | - Elissa Rosen
- ACUTE, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA
| | - Katherine Sachs
- ACUTE, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA
| | - Christine Welles
- ACUTE, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA
| | - Philip S Mehler
- ACUTE, at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA.
- Eating Recovery Center, Denver, 7351E Lowry Blvd, Denver, CO, 80230, USA.
- , Denver, USA.
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17
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Structural Neuroimaging of Anorexia Nervosa: Future Directions in the Quest for Mechanisms Underlying Dynamic Alterations. Biol Psychiatry 2018; 83:224-234. [PMID: 28967386 PMCID: PMC6053269 DOI: 10.1016/j.biopsych.2017.08.011] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 07/21/2017] [Accepted: 08/14/2017] [Indexed: 02/07/2023]
Abstract
Anorexia nervosa (AN) is a serious eating disorder characterized by self-starvation and extreme weight loss. Pseudoatrophic brain changes are often readily visible in individual brain scans, and AN may be a valuable model disorder to study structural neuroplasticity. Structural magnetic resonance imaging studies have found reduced gray matter volume and cortical thinning in acutely underweight patients to normalize following successful treatment. However, some well-controlled studies have found regionally greater gray matter and persistence of structural alterations following long-term recovery. Findings from diffusion tensor imaging studies of white matter integrity and connectivity are also inconsistent. Furthermore, despite the severity of AN, the number of existing structural neuroimaging studies is still relatively low, and our knowledge of the underlying cellular and molecular mechanisms for macrostructural brain changes is rudimentary. We critically review the current state of structural neuroimaging in AN and discuss the potential neurobiological basis of structural brain alterations in the disorder, highlighting impediments to progress, recent developments, and promising future directions. In particular, we argue for the utility of more standardized data collection, adopting a connectomics approach to understanding brain network architecture, employing advanced magnetic resonance imaging methods that quantify biomarkers of brain tissue microstructure, integrating data from multiple imaging modalities, strategic longitudinal observation during weight restoration, and large-scale data pooling. Our overarching objective is to motivate carefully controlled research of brain structure in eating disorders, which will ultimately help predict therapeutic response and improve treatment.
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18
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Kuwabara M, Niwa K, Yamada U, Ohta D. Low body mass index correlates with low left ventricular mass index in patients with severe anorexia nervosa. Heart Vessels 2017; 33:89-93. [PMID: 28887668 DOI: 10.1007/s00380-017-1051-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 09/06/2017] [Indexed: 01/20/2023]
Abstract
The patients with anorexia nervosa (AN) are known to be associated with high mortality, but the actual causes of death are still undefined. We tested the hypothesis that AN patients had cardiac disorders, including left ventricular (LV) dysfunction and LV atrophy. This study is a cross-sectional study at St. Luke's International Hospital, Tokyo. We analyzed 13 female inpatients with AN. We assessed cardiac function and heart volume in AN by echocardiography, LV ejection fraction (LVEF), LV mass, and LV mass index (LVMI). We assessed the correlations between body mass index (BMI) and heart volume (LV mass and LVMI). The mean age and BMI were 34.8 ± 11.2 years and 15.5 ± 3.1 kg/m2, respectively. There was no patient with mitral valve prolapse, but 3 patients had trivial to small amount of pericardial effusion. The mean LVEF was 67.7 ± 6.5%, and 12 out of 13 patients had normal LVEF. Their LV mass (89.0 ± 27.3 g) and LVMI (66.3 ± 16.4 g/m2) were small. BMI positively correlated with LVMI (r = 0.58, p = 0.040), as well as LV mass (r = 0.74, p = 0.004). Lower BMI reflects lower LVMI, as well as smaller LV mass. These issues suggest that heart volume is initially decreased in severe AN conditions. Low LVMI could be a good marker of severity of AN.
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Affiliation(s)
- Masanari Kuwabara
- Department of Cardiology, Cardiovascular Center, St. Luke's International Hospital, 9-1 Akashi-cho, Chuou-ku, Tokyo, 104-8560, Japan. .,Division of Renal Diseases and Hypertension, School of Medicine, University of Colorado Denver, Aurora, CO, USA. .,Department of Cardiology, Toranomon Hospital, Tokyo, Japan.
| | - Koichiro Niwa
- Department of Cardiology, Cardiovascular Center, St. Luke's International Hospital, 9-1 Akashi-cho, Chuou-ku, Tokyo, 104-8560, Japan
| | - Ui Yamada
- Department of Psychosomatic Medicine, Liaison Center, St. Luke's International Hospital, Tokyo, Japan
| | - Daisuke Ohta
- Department of Psychosomatic Medicine, Liaison Center, St. Luke's International Hospital, Tokyo, Japan
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19
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Kalla A, Krishnamoorthy P, Gopalakrishnan A, Garg J, Patel NC, Figueredo VM. Gender and age differences in cardiovascular complications in anorexia nervosa patients. Int J Cardiol 2016; 227:55-57. [PMID: 27846464 DOI: 10.1016/j.ijcard.2016.11.209] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/06/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) is characterized by severe malnutrition and electrolyte imbalances. Differences in cardiovascular complications between males and females with AN have not been studied. Additionally, coronary artery disease (CAD) prevalence and cardiovascular complications in patients with AN >65years have not been reported. METHODS AN patients>18years were identified in the Nationwide Inpatient Sample 2009-2010 database using the Ninth Revision of International Classification of Disease code 307.1. Demographics, risk factors, and cardiovascular event rates were compared to general population data. RESULTS CAD incidence was lower in all AN patients compared to the general population (4.4% vs 18.4%, p<0.001). Despite AN males having higher prevalences of hypertension and diabetes than AN females, there was no difference in CAD. AN males had higher rates of cardiac arrests, arrhythmias, and heart failure. Interestingly, 4.3% of patients with AN were >65years old. When compared to the general population>65years, older AN patients had lower rates of CAD (35% vs 16%; p<0.001). Older AN patients still had higher CAD rates compared to the general population under 65 (8.6%) and AN patients under 65 (4%; p<0.001). Older AN patients had a lower incidence of heart failure (24% vs 16%; p=0.04), and a trend towards less arrhythmias (30% vs 21%; p=0.08). CONCLUSIONS Our data suggests that male AN patients experienced more cardiac arrests, arrhythmias, and heart failure than female AN patients. Additionally, older AN patients have a decreased incidence of CAD and heart failure compared to the general population>65years old.
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Affiliation(s)
- A Kalla
- Institute for Heart & Vascular Health, Einstein Medical Center, United States
| | - P Krishnamoorthy
- Institute for Heart & Vascular Health, Einstein Medical Center, United States
| | - A Gopalakrishnan
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - J Garg
- Lehigh Valley Health Network, Allentown, PA, United States
| | - N C Patel
- Lehigh Valley Health Network, Allentown, PA, United States
| | - V M Figueredo
- Institute for Heart & Vascular Health, Einstein Medical Center, United States; Sidney Kimmel College of Medicine at Thomas Jefferson University, Philadelphia, PA, United States.
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20
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Sardar MR, Greway A, DeAngelis M, Tysko EO, Lehmann S, Wohlstetter M, Patel R. Cardiovascular Impact of Eating Disorders in Adults: A Single Center Experience and Literature Review. Heart Views 2016; 16:88-92. [PMID: 27326349 PMCID: PMC4590190 DOI: 10.4103/1995-705x.164463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Eating disorders have multiple medical sequelae, including potentially life-threatening cardiovascular complications. This article describes our cardiology practice experience of treating adults with eating disorders in the outpatient setting and documents baseline cardiac findings in this complex patient population. We describe our findings in patients across the spectrum of eating disorders; past studies have generally focused on anorexia only. This article also includes a review of the current literature on cardiovascular complications associated with disordered eating.
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Affiliation(s)
| | - Andrea Greway
- Lankenau Heart Institute, Cooper University Hospital, New Jersey, USA
| | - Michael DeAngelis
- Lankenau Heart Institute, Cooper University Hospital, New Jersey, USA
| | | | - Shawn Lehmann
- Renfrew Center, Cooper University Hospital, New Jersey, USA
| | | | - Riti Patel
- Lankenau Heart Institute, Cooper University Hospital, New Jersey, USA
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21
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Abstract
UNLABELLED Introduction Anorexia nervosa is an eating disorder, which is associated with many different medical complications as a result of the weight loss and malnutrition that characterise this illness. It has the highest mortality rate of any psychiatric disorder. A large portion of deaths are attributable to the cardiac abnormalities that ensue as a result of the malnutrition associated with anorexia nervosa. In this review, the cardiac complications of anorexia nervosa will be discussed. METHODS A comprehensive literature review on cardiac changes in anorexia nervosa was carried out. RESULTS There are structural, functional, and rhythm-type changes that occur in patients with anorexia nervosa. These become progressively significant as ongoing weight loss occurs. CONCLUSION Cardiac changes are inherent to anorexia nervosa and they become more life-threatening and serious as the anorexia nervosa becomes increasingly severe. Weight restoration and attention to these cardiac changes are crucial for a successful treatment outcome.
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22
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Sachs KV, Harnke B, Mehler PS, Krantz MJ. Cardiovascular complications of anorexia nervosa: A systematic review. Int J Eat Disord 2016; 49:238-48. [PMID: 26710932 DOI: 10.1002/eat.22481] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Anorexia nervosa portends the highest mortality among psychiatric diseases, despite primarily being a disease of adolescents and younger adults. Although some of this mortality risk is attributable to suicide, many deaths are likely cardiovascular in etiology. Recent studies suggest that adverse myocardial structural changes occur in this condition, which could underlie the increased mortality. Given limited prevalence of severe anorexia there is a paucity of clinical and autopsy data to discern an exact cause of death. METHODS Given this background we conducted a systematic review of the medical literature to provide a contemporary summary of the pathobiologic sequelae of severe anorexia nervosa on the cardiovascular system. We sought to elucidate the impact of anorexia nervosa in four cardiovascular domains: structural, repolarization/conduction, hemodynamic, and peripheral vascular. RESULTS A number of cardiac abnormalities associated with anorexia nervosa have been described in the literature, including pericardial and valvular pathology, changes in left ventricular mass and function, conduction abnormalities, bradycardia, hypotension, and dysregulation in peripheral vascular contractility. Despite the prevalent theory that malignant arrhythmias are implicated as a cause of sudden death in this disorder, data to support this causal relationship are lacking. DISCUSSION It is reasonable to obtain routine electrocardiography and measurements of orthostatic vital signs in patients presenting with anorexia nervosa. Echocardiography is generally not indicated unless prompted by clinical signs of disease. Admission to an inpatient unit with telemetry monitoring is recommended for patients with severe sinus bradycardia or junction rhythm, marked prolongation of the corrected QT interval, or syncope.
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Affiliation(s)
- Katherine V Sachs
- Department of Medicine, Denver Health Medical Center, Denver, Colorado.,University of Colorado School of Medicine, Denver, Aurora
| | - Ben Harnke
- Health Sciences Library, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Philip S Mehler
- Department of Medicine, Denver Health Medical Center, Denver, Colorado.,University of Colorado School of Medicine, Denver, Aurora
| | - Mori J Krantz
- University of Colorado School of Medicine, Denver, Aurora.,Division of Cardiology, Denver Health Medical Center, Denver, Colorado
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23
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Medical complications of anorexia nervosa and their treatments: an update on some critical aspects. Eat Weight Disord 2015; 20:419-25. [PMID: 26138740 DOI: 10.1007/s40519-015-0202-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/17/2015] [Indexed: 12/18/2022] Open
Abstract
Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Many of the deaths are attributable to medical complications which arise as the malnutrition and weight loss worsens. Every body system may be adversely affected by anorexia nervosa. Yet, remarkably, most of the medical complications of anorexia nervosa are treatable and reversible with optimal medical care, as part of a multidisciplinary team who are often involved in the care of these patients. Herein, we will describe the medical complications of anorexia nervosa and their treatments.
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Stewart D, O'Kane L, Hinds J. Perioperative management of severe anorexia nervosa. Br J Anaesth 2015; 114:709-10. [DOI: 10.1093/bja/aev044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Abstract
In contrast to other mental health disorders, eating disorders have a high prevalence of concomitant medical complications. Specifically, patients suffering from anorexia nervosa (AN) have a litany of medical complications which are commonly present as part of their eating disorders. Almost every body system can be adversely, affected by this state of progressive malnutrition. Moreover, some of the complications can have permanent adverse effects even after there is a successful program of nutritional rehabilitation and weight restoration. Within this article we will review all body systems affected by AN. There is also salient information about both, how to diagnose these medical complications and which are the likely ones to result in permanent sequelae if not diagnosed and addressed early in the course of AN. In a subsequent article, the definitive medical treatment for these complications will be presented in a clinically practical manner.
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Affiliation(s)
- Philip S Mehler
- Department of Medicine, University of Colorado Health Sciences Center, ACUTE at Denver Health, and Eating Recovery Center, Denver, CO - 777 Bannock Street, MC4000, Denver, CO 80204, 7351 E Lowry Blvd, Suite 200, Denver, CO 80230 USA
| | - Carrie Brown
- Department of Medicine, University of Colorado Health Sciences Center and ACUTE at Denver Health, Denver, CO - 777 Bannock Street, MC4000, Denver, CO 80204 USA
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26
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Abstract
Despite their high prevalence, associated morbidity and mortality, and available treatment options, eating disorders (EDs) continue to be underdiagnosed by pediatric professionals. Many adolescents go untreated, do not recover, or reach only partial recovery. Higher rates of EDs are seen now in younger children, boys, and minority groups; EDs are increasingly recognized in patients with previous histories of obesity. Medical complications are common in both full and subthreshold EDs and affect every organ system. No single cause of EDs has emerged, although neurobiological and genetic predispositions are emerging as important. Recent treatment paradigms acknowledge that they are not caused by families or chosen by patients. EDs present differently in pediatric populations, and providers should have a high index of suspicion using new Diagnostic and Statistical Manual, 5th edition diagnostic criteria because early intervention can affect prognosis. Outpatient family-based treatment focused on weight restoration, reducing blame, and empowering caregivers has emerged as particularly effective; cognitive behavioral therapy, individual therapy, and higher levels of care may also be appropriate. Pharmacotherapy is useful in specific contexts. Full weight restoration is critical, often involves high-calorie diets, and must allow for continued growth and development; weight maintenance is typically inappropriate in pediatric populations. Physical, nutritional, behavioral, and psychological health are all metrics of a full recovery, and pediatric EDs have a good prognosis with appropriate care. ED prevention efforts should work toward aligning with families and understanding the impact of antiobesity efforts. Primary care providers can be key players in treatment success.
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Affiliation(s)
- Kenisha Campbell
- The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Rebecka Peebles
- The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Perelman School of Medicine at The University of Pennsylvania, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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