Heart rate variability and left ventricular diastolic function in anorexia nervosa

To investigate the cardiac effects of starvation in a group of adolescents with anorexia nervosa (AN). Twenty-five patients with AN (range 13–20 years), compared with 25 age-matched thin and 25 age-matched control women with body mass index > 20 Kg/m 2, underwent a complete clinical evaluation, including echocardiogram and 24-hour electrocardiogram monitoring to evaluate heart rate variability (HRV) indices. Compared to both thin and control women, patients with AN had greater HRV time domain indices (SDNN: 246.5 ± 32.4 vs. 170.4 ± 24 ms and vs. 181 ± 21.2 ms, p < .001), and in the frequency domain a lower LF/HF ratio (4.2 ± 1.3 vs. 6.7 ± 1.2 and vs. 6.8 ± 1.3 ms, p < .001). AN patients showed reduced left ventricular mass with normal systolic function and typical diastolic patterns, characterized by a lower peak velocity transmitral flow in late diastole (peak A: 35.9 ± 8.5 vs. 45.2 ± 7.3 cm/sec and vs. 46.6 ± 6.3 cm/sec, p < .01), a comparable peak velocity in early diastole (peak E: 92.7 ± 12.1 vs. 83 ± 6.2 and vs. 86.8 ± 9.1 cm/sec, ns) and, subsequently, a greater E/A ratio (2.8 ± 0.7 vs. 1.8 ± 0.3 and vs. 1.9 ± .5, p < .01) than thinness and control groups. Moreover, SDNN was also positively related to E/A ratio ( r = .54, p < .01). Our findings demonstrate a cardiovascular vagal hyperactivity in AN , which appears to influence the ventricular diastolic dynamics. HRV and diastolic function analysis may represent useful tools in monitoring anorexia-induced cardiac modifications.