LEFT-VENTRICULAR MASS AND FUNCTION IN CHILDREN WITH SEVERE PROTEIN-ENERGY MALNUTRITION

We studied 25 children, aged 1-5 years (mean 2.65 +/- 0.8 years) with severe protein energy malnutrition, and compared their left ventricula r mass and function to those of 26 healthy, age- and sex-matched norma l children. The mean left ventricular mass in the patients was lower t han that in the controls (25.75 +/- 8.09 g vs. 32.44 +/- 11.64 g; P < 0.05, C.I. 2.08 to 11.30). However, left ventricular mass (g)/kg body weight was significantly increased in the patients (4.44 +/- 1.45 vs. 2.42 +/- 0.87; P < 0.001, C.I. 1.28 to 2.76) suggesting relative cardi ac "sparing". The systolic function indices like ejection fraction, pe rcentage fractional shortening, and velocity of circumferential fiber shortening were not significantly different in the patients and in the normal children. The left ventricular end-diastolic volume, stroke vo lume and cardiac output were reduced in proportion to decrease in body size in the patients, so that the cardiac index was not reduced but s lightly increased in the patients. (5.95 +/- 1.9 l/min/m2 in patients, 4.97 +/- 1.4 l/min/m2 in controls; P < 0.05, C.I. 0.04 to 1.92). Ther e was no significant difference in any of these parameters of left ven tricular function or mass in patients with marasmus, as compared to th ose of patients with marasmic kwashiorkor. Amongst the 25 patients, ho wever, 5 patients (20%) had an ejection fraction of less than 50%. Com pared to the other 20 patients, these 5 patients had lower left ventri cular mass (18.4 +/- 4.3 g vs. 27.5 +/- 7.8 g, P < 0.05 C.I. 1.63 to 1 6.75), lower left ventricular mass (g)/kg body weight and a worse prog nosis. These 5 patients did not differ from the rest of the patients i n any other identifiable respect. Further characterisation of such pat ients may have wider physiological implications. In conclusion: (1) re lative cardiac "sparing" occurs in patients with severe protein energy malnutrition; (2) the systolic functions are preserved in the atrophi c hearts in most of the patients; and (3) in a small number of patient s (20%), with equally severe malnutrition, more myocardial atrophy, re duced ejection fraction and a worse prognosis are seen.