본문 바로가기
KERD
논문KCI 등재

Cardiac Complications Associated with Eating Disorders in Children: A Multicenter Retrospective Study

0

조회

0

다운로드

0

인용

0

참고문헌

키워드

주제분류소아과학

초록

Purpose: Eating disorders often result in somatic complications, including cardiac abnormalities. Cardiac abnormalities may involve any part of the heart, including the cardiac conduction system, and can lead to sudden cardiac death. The current study aimed to evaluate the incidence of cardiac complications in pediatric patients with eating disorders and their associated factors. Methods: We retrospectively analyzed patients aged 10–18 years who were diagnosed with DSM-V (Diagnostic and Statistical Manual of Mental Disorder-V) eating disorders and underwent electrocardiography (ECG) and/or echocardiography between January 2015 and May 2020. Results: In total, 127 patients were included, of whom 113 (89.0%) were female. The median body mass index (BMI) was 15.05±3.69 kg/m2. Overall, 74 patients (58.3%) had ECG abnormalities, with sinus bradycardia being the most common abnormality (91.9%). Patients with ECG abnormalities had significantly lower BMI (14.35±2.78 kg/m2 vs. 16.06± 4.55 kg/m2, p<0.001) than patients without ECG abnormalities, as well as lower phosphorus and higher cholesterol levels. Among the 46 patients who underwent echocardiographic evaluation, 23 (50.0%) had echocardiographic abnormalities, with pericardial effusion being the most common (60.9%). The median left ventricular mass (LVM) and ejection fraction were 67.97±21.25 g and 66.91±28.76%, respectively. LVM and BMI showed a positive correlation (r=0.604, p<0.001). After weight gain, the amount of pericardial effusion was reduced in 3 patients, and 30 patients presented with normal ECG findings. Conclusion: Cardiac abnormalities are relatively frequent in patients with eating disorders. Physicians should focus on this somatic complication and careful monitoring is required.

Abstract

Purpose: Eating disorders often result in somatic complications, including cardiac abnormalities. Cardiac abnormalities may involve any part of the heart, including the cardiac conduction system, and can lead to sudden cardiac death. The current study aimed to evaluate the incidence of cardiac complications in pediatric patients with eating disorders and their associated factors. Methods: We retrospectively analyzed patients aged 10–18 years who were diagnosed with DSM-V (Diagnostic and Statistical Manual of Mental Disorder-V) eating disorders and underwent electrocardiography (ECG) and/or echocardiography between January 2015 and May 2020. Results: In total, 127 patients were included, of whom 113 (89.0%) were female. The median body mass index (BMI) was 15.05±3.69 kg/m2. Overall, 74 patients (58.3%) had ECG abnormalities, with sinus bradycardia being the most common abnormality (91.9%). Patients with ECG abnormalities had significantly lower BMI (14.35±2.78 kg/m2 vs. 16.06± 4.55 kg/m2, p<0.001) than patients without ECG abnormalities, as well as lower phosphorus and higher cholesterol levels. Among the 46 patients who underwent echocardiographic evaluation, 23 (50.0%) had echocardiographic abnormalities, with pericardial effusion being the most common (60.9%). The median left ventricular mass (LVM) and ejection fraction were 67.97±21.25 g and 66.91±28.76%, respectively. LVM and BMI showed a positive correlation (r=0.604, p<0.001). After weight gain, the amount of pericardial effusion was reduced in 3 patients, and 30 patients presented with normal ECG findings. Conclusion: Cardiac abnormalities are relatively frequent in patients with eating disorders. Physicians should focus on this somatic complication and careful monitoring is required.

참고문헌 (40)

  1. Forman SF, "Predictors of outcome at 1 year in adolescents with DSM-5 restrictive eating disorders : report of the national eating disorders quality improvement collaborative", J Adolesc Health, 55, pp.750~756 (2014)
  2. Gosseaume C, "Somatic complications and nutritional management of anorexia nervosa", Clin Nutr Exp, 28, pp.2~10 (2019)
  3. Treasure J, "Eating disorders", Lancet, 395, pp.899~911 (2020)
  4. Westmoreland P, "Medical complications of anorexia nervosa and bulimia", Am J Med, 129, pp.30~37 (2016)
  5. Mehler PS, "Anorexia nervosa-medical complications", J Eat Disord, 3, pp.11~ (2015)
  6. Cass K, "Medical complications of anorexia nervosa", Psychosomatics, 61, pp.625~631 (2020)
  7. Giovinazzo S, "Anorexia nervosa and heart disease : a systematic review", Eat Weight Disord, 24, pp.199~207 (2019)
  8. Sardar MR, "Cardiovascular impact of eating disorders in adults : a single center experience and literature review", Heart Views, 16, pp.88~92 (2015)
  9. Harrington BC, "Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa", Am Fam Physician, 91, pp.46~52 (2015)
  10. Mont L, "Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery", J Am Acad Child Adolesc Psychiatry, 42, pp.808~813 (2003)
  11. Kastner S, "Echocardiographic findings in adolescents with anorexia nervosa at beginning of treatment and after weight recovery", Eur Child Adolesc Psychiatry, 21, pp.15~21 (2012)
  12. Fleming S, "Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age : a systematic review of observational studies", Lancet, 377, pp.1011~1018 (2011)
  13. Haque IU, "Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children", Pediatr Crit Care Med, 8, pp.138~144 (2007)
  14. Bazett HC, "An analysis of the time-relations of electrocardiograms", Ann Noninvasive Electrocardiol, 2, pp.177~194 (1997)
  15. Devereux RB, "Echocardiographic assessment of left ventricular hypertrophy : comparison to necropsy findings", Am J Cardiol, 57, pp.450~458 (1986)
  16. Silverman NH, "Determination of left ventricular volume in children : echocardiographic and angiographic comparisons", Circulation, 62, pp.548~557 (1980)
  17. Kalla A, "Gender and age differences in cardiovascular complications in anorexia nervosa patients", Int J Cardiol, 227, pp.55~57 (2017)
  18. Casiero D, "Cardiovascular complications of eating disorders", Cardiol Rev, 14, pp.227~231 (2006)
  19. Sullivan PF, "Mortality in anorexia nervosa", Am J Psychiatry, 152, pp.1073~1074 (1995)
  20. Isner JM, "Anorexia nervosa and sudden death", Ann Intern Med, 102, pp.49~52 (1985)
  21. Sharp CW, "The medical complications of anorexia nervosa", Br J Psychiatry, 162, pp.452~462 (1993)
  22. Neumärker KJ, "Mortality and sudden death in anorexia nervosa", Int J Eat Disord, 21, pp.205~212 (1997)
  23. Yahalom M, "The significance of bradycardia in anorexia nervosa", Int J Angiol, 22, pp.83~94 (2013)
  24. Anderson E, "Extreme bradycardia as presentation of an eating disorder", BMJ Case Rep, 14, pp.e238224~ (2021)
  25. Spaulding-Barclay MA, "Cardiac changes in anorexia nervosa", Cardiol Young, 26, pp.623~628 (2016)
  26. Marín B V, "Female adolescents with eating disordes: cardiac abnormalities", Rev Med Chil, 147, pp.47~52 (2019)[DOI]
  27. Kollai M, "Cardiac vagal hyperactivity in adolescent anorexia nervosa", Eur Heart J, 15, pp.1113~1118 (1994)
  28. Cooke RA, "QT interval in anorexia nervosa", Br Heart J, 72, pp.69~73 (1994)
  29. Panagiotopoulos C, "Electrocardiographic findings in adolescents with eating disorders", Pediatrics, 105, pp.1100~1105 (2000)
  30. Uvelin A, "Acquired prolongation of QT interval as a risk factor for torsade de pointes ventricular tachycardia : a narrative review for the anesthesiologist and intensivist", J Anesth, 31, pp.413~423 (2017)
  31. Bazoukis G, "Association of QT dispersion with mortality and arrhythmic events-a meta-analysis of observational studies", J Arrhythm, 36, pp.105~115 (2019)
  32. DiVasta AD, "Malnutrition and hemodynamic status in adolescents hospitalized for anorexia nervosa", Arch Pediatr Adolesc Med, 164, pp.706~713 (2010)
  33. Vedel-Larsen E, "Major rapid weight loss induces changes in cardiac repolarization", J Electrocardiol, 49, pp.467~472 (2016)
  34. Zhu W, "Relation of body mass index with adverse outcomes among patients with atrial fibrillation : a meta-analysis and systematic review", J Am Heart Assoc, 5, pp.e004006~ (2016)
  35. Swenne I, "Heart risk associated with weight loss in anorexia nervosa and eating disorders : risk factors for QTc interval prolongation and dispersion", Acta Paediatr, 88, pp.304~309 (1999)
  36. Rigaud D, "Hypercholesterolaemia in anorexia nervosa : frequency and changes during refeeding", Diabetes Metab, 35, pp.57~63 (2009)
  37. Inagaki T, "Echocardiographic investigation of pericardial effusion in a case of anorexia nervosa", Int J Eat Disord, 33, pp.364~366 (2003)
  38. Dai S, "Effects of body size and body fatness on left ventricular mass in children and adolescents: Project HeartBeat!", Am J Prev Med, 37(1), pp.S97~104 (2009)
  39. Guleri N, "Study of left ventricular mass and its determinants on echocardiography", J Clin Diagn Res, 11, pp.13~16 (2017)
  40. Escudero CA, "An echocardiographic study of left ventricular size and cardiac function in adolescent females with anorexia nervosa", Eur Eat Disord Rev, 24, pp.26~33 (2016)

관련 논문AI추천

이 간행물의 다른 논문 (7건)