CARDIAC ABNORMALITIES IN YOUNG-WOMEN WITH ANOREXIA-NERVOSA

Objective-To identify the characteristics of cardiac involvement in th e self-induced starvation phase of anorexia nervosa. Methods-Doppler e chocardiographic indices of left ventricular geometry, function, and f illing were examined in 21 white women (mean (SD) 22 (5) years) with a norexia nervosa according to the DSMIII diagnostic and Statistical Man ual of Mental Disorders) criteria, 19 women (23 (2) years) of normal w eight, and 22 constitutionally thin women (21 (4) years) with body mas s index < 20. Results-13 patients (62%) had abnormalities of mitral va lve motion compared with one normal weight woman and two thin women (p < 0.001) v both control groups). Left ventricular chamber dimension a nd mass were significantly less in women with anorexia nervosa than in either the women of normal weight or the thin women, even after stand ardisation for body size or after controlling for blood pressure. Ther e were no substantial changes in left ventricular shape. Midwall short ening as a percentage of the values predicted from end systolic stress was significantly lower in the starving patients than in women of nor mal weight: when endocardial shortening was used as the index this dif ference was overestimated. The cardiac index was also significantly re duced in anorexia nervosa because of a low stroke index and heart rate . The total peripheral resistance was significantly higher in starving patients than in both control groups. The left atrial dimension was s ignificantly smaller in anorexia than in the women of normal weight an d the thin women, independently of body size. The transmitral flow vel ocity EIA ratio was significantly higher in anorexia than in both the control groups because of the reduction of peak velocity A. When data from all three groups were pooled the flow velocity EIA ratio was inve rsely related to left atrial dimension (r = -0.43, p < 0.0001) and car diac output (r = -0.64, p < 0.0001) independently of body size. Conclu sions-Anorexia nervosa caused demonstrable abnormalities of mitral val ve motion and reduced left ventricular mass and filling associated wit h systolic dysfunction.