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. 2022 Mar 24;9(4):458.
doi: 10.3390/children9040458.

Cardiac Remodeling and Its Determinants in Anorexia Nervosa Adolescents: Impact of Weight Recovery

Justine Paysal  1   2 , Jérôme Thireau  3 , Daniel Terral  4 , Emmanuelle Rochette  4   5 , Philippe Obert  1 , Etienne Merlin  4   5 , Stéphane Nottin  1
Affiliations

Cardiac Remodeling and Its Determinants in Anorexia Nervosa Adolescents: Impact of Weight Recovery

Justine Paysal et al. Children (Basel). .

Abstract

Cardiovascular alterations in anorexia nervosa (AN) adolescents include bradycardia and decreased systolic blood pressure and left ventricular mass. However, their determinants remain poorly understood. We assessed the associations between morphological and functional left ventricular (LV) remodeling, autonomic control by heart rate variability (HRV) analysis, thyroid hormones and brain natriuretic peptide (BNP) levels in AN female adolescents without or with weight recovery (WR). Fifty-nine female adolescents including 16 AN patients without WR (mean age 13.9 years (10−16)), 10 AN patients with WR (15.7 years (12−18)) and 33 controls (14.1 years (10−18)) underwent night heart rate (HR) recording to measure HRV (and especially SD1/SD2, the ratio between instantaneous (SD1) and long-term (SD2) standard deviation of R-R intervals, reflecting sympatho-vagal balance), speckle tracking echocardiography to assess LV global longitudinal strain (GLS) and blood test for dosage of tri-iodothyronine (T3) hormone and NT-proBNP. Compared to controls, AN patients without WR presented with lower HR (55 ± 7 vs. 68 ± 6 bpm; p < 0.001), parasympathetic hyperactivity, and higher GLS (−19.2 ± 1.8 vs. −16.9 ± 2.8%; p = 0.009). These alterations were partly abolished in AN patients with WR. In a multivariate regression analysis, T3 was the main factor explaining the variance of SD1/SD2, a sympatho-vagal balance marker. NT-proBNP levels were not correlated with cardiac alterations. AN patients had parasympathetic hyperactivity linked with their rate of T3, and a higher GLS. These alterations were partly restored in AN patients with WR.

Keywords: anorexia nervosa; heart rate variability; speckle tracking echocardiography; thyroid hormones.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patterns of the BMI z score from the beginning of the eating disorder in AN patients without WR (in green, solid line) and in AN patients with WR (in orange, dotted line). In black: controls.
Figure 2
Figure 2
Biological data of AN patients (with, in orange, and without WR, in green) and controls (in grey): T4, T3, TSH and NT-proBNP. ***: significantly different from Controls (p < 0.001); #: Significantly different from AN patients with WR (p < 0.05).
Figure 3
Figure 3
Heart rate variability parameters of AN patients (with, in orange and without WR, in green) and controls (in grey). Significantly different from Controls (*: p < 0.05; **: p < 0.01; ***: p < 0.001); Significantly different from AN patients with WR (#: p <0.05; ##: p <0.01; ###: p < 0.001).
Figure 4
Figure 4
Relations between HR and HRV parameters (PNN50, RMSSD, SD1, SD1/SD2) with a single linear regression. Orange circles: AN patients with WR, green circles: AN patients without WR and grey circles: Controls.
Figure 5
Figure 5
Relations between biological markers (T3 and NT-proBNP) and resting HR or HRV parameters (p NN50, SD1/SD2) with a single linear regression. Orange circles: AN patients with WR, green circles: AN patients without WR and grey circles: Controls.
See this image and copyright information in PMC

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