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神经性厌食症青少年心血管功能障碍的标志物

Markers of Cardiovascular Dysfunction in Adolescents With Anorexia Nervosa.

作者信息

Morris Reshmi, Prasad Aparna, Asaro Joseph, Guzman Marla, Sanders Leslie, Hauck Amanda, Singh Gautam K, Levy Philip T

机构信息

Goryeb Children's Hospital, Atlantic Health System, Morristown, NJ, USA.

Northwestern University, Feinberg School of Medicine, Chicago, IL, USA.

出版信息

Glob Pediatr Health. 2017 Aug 29;4:2333794X17727423. doi: 10.1177/2333794X17727423. eCollection 2017.

Abstract

. Cardiovascular complications contribute to the high morbidity and mortality rate among children with anorexia nervosa (AN). Advances in cardiac imaging permit a more comprehensive assessment of myocardial performance in children that could not be previously obtained with conventional imaging. Myocardial strain analysis is an emerging quantitative echocardiographic technique to characterize global and regional ventricular function in children. . To assess global and regional left ventricular (LV0 function in children newly diagnosed with AN with conventional and quantitative 2-dimensional speckle tracking echocardiographic (2DSTE)-derived strain imaging. . In a cross-sectional study of 30 patients with AN () and 14 age-, sex-, and race-matched healthy children, markers of cardiovascular risk, conventional and 2DSTE measures of LV function, and structure were evaluated and compared. The AN cohort was further stratified by behavioral patterns (restrict, exercise, or purge). . Conventional measures and LV global strain were similar between controls and children with AN. A subgroup of AN children with purging behavior had LV remodeling characterized by significantly decreased LV mass index. Regional ventricular function at the apex, as measured by strain, was also decreased in all AN patients. Percent change from ideal body weight, body mass index -score, electrolyte profiles, heart rate, and blood pressure were similar. . Subclinical regional ventricular dysfunction is present in children with AN. Ventricular remodeling exists in a subgroup of children with AN in association with purging behavior. Future studies may utilize strain imaging to identify those AN patients who are at an increased risk for developing significant cardiac dysfunction.

摘要

心血管并发症导致神经性厌食症(AN)患儿的高发病率和死亡率。心脏成像技术的进步使得对儿童心肌功能进行更全面的评估成为可能,而这在以前使用传统成像方法时是无法实现的。心肌应变分析是一种新兴的定量超声心动图技术,用于表征儿童的整体和局部心室功能。为了使用传统的和基于二维斑点追踪超声心动图(2DSTE)的应变成像定量评估新诊断为AN的儿童的整体和局部左心室(LV)功能。在一项对30例AN患者和14例年龄、性别和种族匹配的健康儿童的横断面研究中,对心血管风险标志物、LV功能的传统和2DSTE测量值以及结构进行了评估和比较。AN队列进一步按行为模式(限制饮食、运动或清除行为)进行分层。对照组和AN患儿之间的传统测量值和LV整体应变相似。有清除行为的AN患儿亚组存在LV重塑,其特征是LV质量指数显著降低。所有AN患者的心尖部局部心室功能,通过应变测量,也有所下降。与理想体重的百分比变化、体重指数评分、电解质谱、心率和血压相似。AN患儿存在亚临床局部心室功能障碍。AN患儿亚组存在与清除行为相关的心室重塑。未来的研究可能会利用应变成像来识别那些发生严重心脏功能障碍风险增加的AN患者。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0c8f/5580842/57b5c606e053/10.1177_2333794X17727423-fig1.jpg

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