Background Anorexia Nervosa (AN) is a complex psychiatric disorder that can lead to specific somatic complications. Heart abnormalities are frequently reported, while their frequency and associated factors in severely malnourished AN patients remain poorly defined. Objectives This study aimed to characterize echocardiographic abnormalities in severely malnourished AN patients and to assess associated clinical, biological and related body composition features. Methods Between January 2013 and January 2015, all severely malnourished adult patients with AN (Mental Disorders, 4th Edn.-DSM IVr) were included in a monocentric study performed in in a highly specialized AN inpatient unit. Electrocardiogram (ECG) and echocardiography were used to assess both heart rhythm and function. All inpatients underwent a Doppler echocardiography procedure after undergoing combined blood volume adjustment, micronutrients deficiencies supplementation and electrolyte disorders correction. Right Ventricular (RV) and Left Ventricular (LV) systolic and diastolic functions were collected and compared to 29 healthy normal subjects in a control group. Results One hundred and 24 patients (119 (96%) women, 5 (4%) men) with a mean age of 30.1 ± 11 years old and an average Body Mass Index (BMI) of 12 kg/m 2 were included. Ninety patients (73%) had been diagnosed with AN Restrictive type (AN-R), 34 (27%) an AN Binge eating/Purging type (AN-BP). Eighteen patients (15%) disclosed an abnormal Left Ventricular Ejection Fraction (LVEF) (< 52% for male and < 54% for female). LVEF impairment was associated with AN-BP patients ( p < 0.017) and hypertransaminasemia (AST and/or ALT ≥2 N) ( p < 0.05). Left Ventricular mass (LV mass) and Left Ventricular End Diastolic Diameter (LVEDD) were significantly reduced in patients ( p < 0.001, p < 0.001). Left and right ventricular tissue Doppler Imaging Velocities (TDI) peak were reduced in patients: Septal and Lateral LV Sm velocities peaks respectively 10 ± 2 cm/s (vs 14 ± 2 cm/s in controls, p < 0.001), 12 ± 3 cm/s (vs 16 ± 3 cm/s in controls, p < 0.001), basal RV Sm velocity peaks at 14 ± 3 cm/s (vs 19 ± 3 cm/s in controls, p < 0.001). Additionally, LV and RV diastolic velocity peaks were reduced: LV septal and lateral velocity peaks were respectively 13 ± 3 cm/s (vs 18 ± 2 cm/s p < 0.001), 12 ± 3 cm/s (vs 22 ± 4 cm/s, p < 0.001) and RV diastolic velocity peaks at 14 ± 3 cm/s (vs 21 ± 4 cm/s p < 0.001). LV diastolic velocity TDI peaks were significantly associated with hypertransaminasemia ( p < 0.05) and tended to be associated with a low all body Fat-Free Mass Index (FFMI) (using Dual-energy X- ray Absorptiometry (DXA) (HOLOGICQDR 4500) ( p = 0.056). Thirty-four patients (27%) had a pericardial effusion and were significantly associated with a decreased all body FFMI ( p < 0.036). Conclusion Heart abnormalities are frequent in malnourished patients with AN, particularly in AN-BP type. Both liver enzymes and body composition abnormalities tended to be associated with heart dysfunction (non-significant association). Prospective studies are needed to better characterize and describe the evolution of cardiac abnormalities during the refeeding period and subsequent weight restoration.

中文翻译：

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124 名严重营养不良成人神经性厌食症患者的超声心动图异常：频率及其与身体成分和生物学特征的关系

背景神经性厌食症 (AN) 是一种复杂的精神疾病，可导致特定的躯体并发症。心脏异常经常被报道，而在严重营养不良的 AN 患者中其频率和相关因素仍然不明确。目的 本研究旨在表征严重营养不良的 AN 患者的超声心动图异常，并评估相关的临床、生物学和相关身体成分特征。方法 2013 年 1 月至 2015 年 1 月，所有严重营养不良的成年 AN（精神障碍，第 4 版-DSM IVr）患者都被纳入在高度专业化的 AN 住院病房进行的单中心研究。心电图 (ECG) 和超声心动图用于评估心律和功能。所有住院患者在联合血容量调整、微量营养素缺乏补充和电解质紊乱纠正后均接受了多普勒超声心动图检查。收集右心室 (RV) 和左心室 (LV) 收缩和舒张功能，并与对照组中的 29 名健康正常受试者进行比较。结果 1024 名患者（119 (96%) 名女性，5 (4%) 名男性）平均年龄为 30.1 ± 11 岁，平均体重指数 (BMI) 为 12 kg/m 2 。90 名患者 (73%) 被诊断为 AN 限制型 (AN-R)，34 名 (27%) 为 AN 暴食/清除型 (AN-BP)。18 名患者 (15%) 披露了异常的左心室射血分数 (LVEF)（男性 < 52% 和女性 < 54%）。LVEF 受损与 AN-BP 患者相关（p < 0. 017) 和高转氨酶血症（AST 和/或 ALT ≥2 N）（p < 0.05）。患者的左心室质量（LV 质量）和左心室舒张末期直径（LVEDD）显着降低（p < 0.001，p < 0.001）。左心室和右心室组织多普勒成像速度 (TDI) 峰值在患者中降低：室间隔和横向 LV Sm 速度峰值分别为 10 ± 2 cm/s（对照 14 ± 2 cm/s，p < 0.001），12 ± 3 cm/s (vs 16 ± 3 cm/s in control, p < 0.001), 基础 RV Sm 速度峰值在 14 ± 3 cm/s (vs 19 ± 3 cm/s in control, p < 0.001)。此外，LV 和 RV 舒张速度峰值降低：LV 间隔和横向速度峰值分别为 13 ± 3 cm/s (vs 18 ± 2 cm/sp < 0.001)、12 ± 3 cm/s (vs 22 ± 4 cm/ s, p < 0.001) 和 RV 舒张速度峰值为 14 ± 3 cm/s (vs 21 ± 4 cm/sp < 0.001)。