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A PILOT STUDY TO ASSESS CARDIAC ABNORMALITIES IN SEVERE ANOREXIA NERVOSA PATIENTS USING CARDIAC MAGNETIC RESONANCE IMAGING
Abstracts
S151
RESULTS:
Sixty-two patients (5214 years) underwent AVR for severe AR had preoperative and postoperative echocardiograms (median time to postoperative echocardiogram 43 days). The LVEDDI measured 3.20.5 cm/m2 and LVESDI 2.30.6 cm/m2. The LVEDVI was 13250 ml/m2 and LVESVI was 6237 ml/m2. The end-diastolic sphericity index (LV minor to major axis ratio), measured 0.650.07 and the end-systolic sphericity index, 0.550.09. The LVEF was 53%10%. Seventy-four percent of patients met LVESVI remodelling criteria. Multivariate analysis demonstrated that preoperative LV end-diastolic diameter, LVEDVI, LVESVI and LVEF were predictors of LV remodeling (all p<0.01). Thirteen (23%) patients had a severely dilated LV end-diastolic diameter but up to 38 patients (67%) had severely dilated LVEDVI as measured by the method of discs. Therefore, 27 (44%) patients were reclassified as having a severely dilated end-diastolic LV by volumetric measurements over dimensions. Similarly, 9 (16%) patients had severely dilated LV end-systolic diameter but 34 (60%) patients had severely dilated LVESVI. Twenty-five (40%) patients were reclassified as having a severely dilated end-systolic LV by volumetric measurements over dimensions. CONCLUSION: In patients undergoing AVR for isolated severe AR, the LV volumetric measurements by the method of discs are more accurate to classify the LV dilatation associated with severe AR. Pre-operative LVEDVI, LVESVI, LVEF and LV end-diastolic diameter were the best predictors of post-operative LV remodeling. Classification of severity LV dimensions according to linear and volumetric dimensions n=62 n % LV end-diastolic diameter ≥ 6.5 cm
13 23
LVEDV Ind ≥ 100/80 ml/m2
38 67
Reclassification of LV size as being severely dilated based on volumetric measurement
27 44
LV end-systolic diameter ≥ 5 cm
9 16
LVESV Ind ≥ 45/40 ml/m2
34 60
Reclassification of LV size as being severely dilated based on volumetric measurement
25 40
Cardiac evaluation of patients with anorexia nervosa generally involves routine ECG and transthoracic echocardiography. Little is known on the role of cardiac magnetic resonance imaging (CMR) for the noninvasive characterization of cardiac abnormalities in this patient cohort. The objective of this study is to characterize baseline CMR findings in adolescent patients who have been diagnosed with severe anorexia nervosa. METHODS/RESULTS: This is a cross sectional study evaluating the use of CMR in patients with anorexia nervosa. All patients met the DSM V anorexia nervosa diagnostic criteria with a body mass index of < 18.5 kg/m2 at the time of diagnosis. We used a CMR protocol assessing cardiac anatomy, functional assessment including flow, and myocardial delayed enhancement at a single tertiary center. We analyzed 16 female patients with an average age of 17 years (range 13-22 years). The average body mass index (BMI) was 20 kg/m2 (range 17-26 kg/m2). The average LVEF was 55.3% (range 46.1-60.2%) and RVEF was 51.4% (range 41.2-61.4%). The average LV stroke volume was 39 mL (range 34.8-46.3 mL) and average RV stroke volume was 35.7 mL (range 22.1-49.2 mL; Table 1). There was no delayed enhancement, suggestive of myocardial fibrosis, in any of the patients. CONCLUSION: There were significant changes in stroke volumes and ejection fraction in the left and right ventricles in patients with severe anorexia nervosa as compared to published literature controls. In contrast to previous studies, there was no evidence of myocardial fibrosis in these patients. Some of our patients are partly treated for AN. Further research is needed to determine if these significant changes in cardiac parameters are progressive or if they are potentially reversible with treatment. Table 1: CMR findings in a population with anorexia nervosa compared to reference values Parameter
Adult reference values Study population Mean+/(females) Mean+/STD(range), N= 16 STD(range)
p value
LV end diastolic volume/BSA
71.4 ± 6.6 (61.4-86.2)
78 ± 8.7 (61-95)
0.0007
LV end systolic volume/BSA
32.5 ± 5.0 (24.8-46.6)
26 ± 4.7 (17-35)
0.0001
LV stroke volume/BSA
39.0 ± 2.8 (34.8-46.3)
52 ± 6.2 (40-64)
< 0.0001
LV ejection fraction 55.3 ± 4.2 (46.1-60.2)
67 ± 4.6 (58-76)
< 0.0001
LV mass/BSA
45.5 ± 4.3 (39.0-54.3)
62 ± 7.5 (47-77)
< 0.0001
RV end diastolic volume/BSA
69.9 ± 9.7 (53.7-85.3)
78 ± 9 (60-96)
0.0045
K Chu, I Buffo, M Lane, L Ludwig, D Jassal, DI Schantz
RV end systolic volume/BSA
32.2 ± 5.5 (26.0-44.3)
28 ± 7 (14-42)
0.008
Winnipeg, Manitoba
RV stroke volume/BSA
35.7 ± 7.5 (22.1-49.2)
50 ± 6 (38-62)
< 0.0001
BACKGROUND:
RV ejection 51.4 ± 6.3 (41.2-61.4) 64 ± 6 (52-76) fraction Abbr: BSA: body surface area, LV: left ventricular, RV: right ventricular
149 A PILOT STUDY TO ASSESS CARDIAC ABNORMALITIES IN SEVERE ANOREXIA NERVOSA PATIENTS USING CARDIAC MAGNETIC RESONANCE IMAGING
Anorexia nervosa (AN) is associated with numerous cardiac abnormalities including bradyarrythmias, decreased myocardial mass and function, and pericardial effusions. This patient population has an increased mortality rate in comparison to other psychiatric illnesses.
Manitoba Medical Services Foundation
S151
RESULTS:
Sixty-two patients (5214 years) underwent AVR for severe AR had preoperative and postoperative echocardiograms (median time to postoperative echocardiogram 43 days). The LVEDDI measured 3.20.5 cm/m2 and LVESDI 2.30.6 cm/m2. The LVEDVI was 13250 ml/m2 and LVESVI was 6237 ml/m2. The end-diastolic sphericity index (LV minor to major axis ratio), measured 0.650.07 and the end-systolic sphericity index, 0.550.09. The LVEF was 53%10%. Seventy-four percent of patients met LVESVI remodelling criteria. Multivariate analysis demonstrated that preoperative LV end-diastolic diameter, LVEDVI, LVESVI and LVEF were predictors of LV remodeling (all p<0.01). Thirteen (23%) patients had a severely dilated LV end-diastolic diameter but up to 38 patients (67%) had severely dilated LVEDVI as measured by the method of discs. Therefore, 27 (44%) patients were reclassified as having a severely dilated end-diastolic LV by volumetric measurements over dimensions. Similarly, 9 (16%) patients had severely dilated LV end-systolic diameter but 34 (60%) patients had severely dilated LVESVI. Twenty-five (40%) patients were reclassified as having a severely dilated end-systolic LV by volumetric measurements over dimensions. CONCLUSION: In patients undergoing AVR for isolated severe AR, the LV volumetric measurements by the method of discs are more accurate to classify the LV dilatation associated with severe AR. Pre-operative LVEDVI, LVESVI, LVEF and LV end-diastolic diameter were the best predictors of post-operative LV remodeling. Classification of severity LV dimensions according to linear and volumetric dimensions n=62 n % LV end-diastolic diameter ≥ 6.5 cm
13 23
LVEDV Ind ≥ 100/80 ml/m2
38 67
Reclassification of LV size as being severely dilated based on volumetric measurement
27 44
LV end-systolic diameter ≥ 5 cm
9 16
LVESV Ind ≥ 45/40 ml/m2
34 60
Reclassification of LV size as being severely dilated based on volumetric measurement
25 40
Cardiac evaluation of patients with anorexia nervosa generally involves routine ECG and transthoracic echocardiography. Little is known on the role of cardiac magnetic resonance imaging (CMR) for the noninvasive characterization of cardiac abnormalities in this patient cohort. The objective of this study is to characterize baseline CMR findings in adolescent patients who have been diagnosed with severe anorexia nervosa. METHODS/RESULTS: This is a cross sectional study evaluating the use of CMR in patients with anorexia nervosa. All patients met the DSM V anorexia nervosa diagnostic criteria with a body mass index of < 18.5 kg/m2 at the time of diagnosis. We used a CMR protocol assessing cardiac anatomy, functional assessment including flow, and myocardial delayed enhancement at a single tertiary center. We analyzed 16 female patients with an average age of 17 years (range 13-22 years). The average body mass index (BMI) was 20 kg/m2 (range 17-26 kg/m2). The average LVEF was 55.3% (range 46.1-60.2%) and RVEF was 51.4% (range 41.2-61.4%). The average LV stroke volume was 39 mL (range 34.8-46.3 mL) and average RV stroke volume was 35.7 mL (range 22.1-49.2 mL; Table 1). There was no delayed enhancement, suggestive of myocardial fibrosis, in any of the patients. CONCLUSION: There were significant changes in stroke volumes and ejection fraction in the left and right ventricles in patients with severe anorexia nervosa as compared to published literature controls. In contrast to previous studies, there was no evidence of myocardial fibrosis in these patients. Some of our patients are partly treated for AN. Further research is needed to determine if these significant changes in cardiac parameters are progressive or if they are potentially reversible with treatment. Table 1: CMR findings in a population with anorexia nervosa compared to reference values Parameter
Adult reference values Study population Mean+/(females) Mean+/STD(range), N= 16 STD(range)
p value
LV end diastolic volume/BSA
71.4 ± 6.6 (61.4-86.2)
78 ± 8.7 (61-95)
0.0007
LV end systolic volume/BSA
32.5 ± 5.0 (24.8-46.6)
26 ± 4.7 (17-35)
0.0001
LV stroke volume/BSA
39.0 ± 2.8 (34.8-46.3)
52 ± 6.2 (40-64)
< 0.0001
LV ejection fraction 55.3 ± 4.2 (46.1-60.2)
67 ± 4.6 (58-76)
< 0.0001
LV mass/BSA
45.5 ± 4.3 (39.0-54.3)
62 ± 7.5 (47-77)
< 0.0001
RV end diastolic volume/BSA
69.9 ± 9.7 (53.7-85.3)
78 ± 9 (60-96)
0.0045
K Chu, I Buffo, M Lane, L Ludwig, D Jassal, DI Schantz
RV end systolic volume/BSA
32.2 ± 5.5 (26.0-44.3)
28 ± 7 (14-42)
0.008
Winnipeg, Manitoba
RV stroke volume/BSA
35.7 ± 7.5 (22.1-49.2)
50 ± 6 (38-62)
< 0.0001
BACKGROUND:
RV ejection 51.4 ± 6.3 (41.2-61.4) 64 ± 6 (52-76) fraction Abbr: BSA: body surface area, LV: left ventricular, RV: right ventricular
149 A PILOT STUDY TO ASSESS CARDIAC ABNORMALITIES IN SEVERE ANOREXIA NERVOSA PATIENTS USING CARDIAC MAGNETIC RESONANCE IMAGING
Anorexia nervosa (AN) is associated with numerous cardiac abnormalities including bradyarrythmias, decreased myocardial mass and function, and pericardial effusions. This patient population has an increased mortality rate in comparison to other psychiatric illnesses.
Manitoba Medical Services Foundation