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Myocardial mechanics and cardiac biomarkers in adults with severe anorexia nervosa

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Abstract

Background

Anorexia nervosa (AN) is associated with left ventricular (LV) atrophy and unexplained sudden death. Myocardial mechanics have not been well studied in adults with AN. Whether LV mass or illness duration, markers of AN severity, correlate with abnormal strain imaging is unknown.

Methods

We performed a prospective study among patients hospitalized with severe AN (n = 29) [body mass index (BMI) < 14.5 kg/m2] and sex/age-matched controls (n = 16) (BMI > 18.5 kg/m2). LV ejection fraction (LVEF) was calculated via modified-biplane method and LV mass was derived using the truncated ellipsoid formula. Apical 2-, 3-, and 4-chamber images were used to generate regional strain mapping and global longitudinal strain (GLS). N-terminal brain natriuretic peptide (NT-proBNP) levels were measured and linear regression was used to determine independent predictors of strain.

Results

Mean LVEF did not differ (65% ± 6.0 vs. 62% ± 4.4, p = 0.06), but LV mass was substantially reduced (61.6 ± 16.8 vs. 97.6 ± 19.1 g, p < .0001). GLS was similar (− 20.6 ± 3.8 vs. − 20.9 ± 2.8, p = 0.82), however, the basal strain was worse (-18.7 ± 4.8 vs. -21.9 ± 4.1, p = 0.03). Lower LV mass was associated with worsening GLS (r = − 0.40, p = 0.003), but not among controls (p = 0.89). Median (IQR) NT-proBNP (pg/ml) was higher in patients with AN [141 (59–257) vs. 35.5 (21–56.5) p = 0.0007]. Both increasing NT-proBNP and illness duration were associated with worsening strain patterns in AN (both p = .001).

Conclusions

While LVEF and GLS did not differ, regional strain variation was noted among patients with AN. Elevated NT-proBNP may reflect increased wall tension from LV atrophy. Whether strain heterogeneity can identify patients with AN, at risk for sudden death, requires further study.

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Acknowledgements

We are grateful to Dr. Morteza Farasat for his role in interpreting the study echocardiograms. We thank Michelle Henry RDMS, Tiffany Bendelow MPH, and Kelly Maebane for their support. Additionally, we are grateful to Claire Krantz for study participation and assistance with recruitment of healthy controls. We thank the staff of ACUTE for logistical support and outstanding care of this vulnerable population.

Funding

This work was supported by the Shana Glassman Memorial Endowed Chair in General Internal Medicine at Denver Health.

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Authors and Affiliations

  1. Division of Cardiology and Nephrology, US Food and Drug Administration, Silver Spring, MD, USA

    Mori J. Krantz

  2. Department of Medicine, University of Colorado School of Medicine, 13001 E 17Th Pl, Aurora, CO, 80045, USA

    Mori J. Krantz, Ashlie Watters & Philip S. Mehler

  3. The ACUTE Center for Eating Disorders, 723 Delaware Street, Denver, CO, 80204, USA

    Ashlie Watters, Megan Frazier & Philip S. Mehler

  4. Department of Medicine, Denver Health Hospital Authority, 780 Bannock Street, Denver, CO, 80204, USA

    Judy Oakes & Philip S. Mehler

  5. Eating Recovery Center, 7351 E Lowry Blvd, Denver, CO, 80230, USA

    Philip S. Mehler

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  1. Mori J. Krantz
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Correspondence to Philip S. Mehler.

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Conflict of interest

Mori J. Krantz, Ashlie Watters, Judy Oakes, Megan Frazier and Philip S. Mehler declare that they have no relevant conflicts of interest.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. Informed consent was obtained from all patients for being included in the study.

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Krantz, M.J., Watters, A., Oakes, J. et al. Myocardial mechanics and cardiac biomarkers in adults with severe anorexia nervosa. J Echocardiogr (2023). https://doi.org/10.1007/s12574-023-00629-5

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  • DOI: https://doi.org/10.1007/s12574-023-00629-5

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