Objective-To identify the characteristics of cardiac involvement in the self-induced starvation phase of anorexia nervosa. Methods-Doppler echocardiographic indices ofleft ventricular geometry, function, and filling were examined in 21 white women (mean (SD) 22 (5) years) with anorexia nervosa according to the DSMIII (Diagnostic and Statistical Manual of Mental Disorders) criteria, 19 women (23 (2) years) of normal weight, and 22 constitutionally thin women (21 (4) years) with body mass index <20. Results-13 patients (62%) had abnormalities of mitral valve motion compared with one normal weight woman and two thin women (p < 0-001) v both control groups). Left ventricular chamber dimension and mass were significantly less in women with anorexia nervosa than in either the women of normal weight or the thin women, even after standardisation for body size or after controlling for blood pressure. There were no substantial changes in left ventricular shape. Midwall shortening as a percentage of the values predicted from end systolic stress was significantly lower in the starving patients than in women of normal weight: when endocardial shortening was used as the index this difference was overestimated. The cardiac index was also significantly reduced in anorexia nervosa because of a low stroke index and heart rate. The total peripheral resistance was significantly higher in starving patients than in both control groups. The left atrial dimension was significantly smaller in anorexia than in the women of normal weight and the thin women, independently of body size. The transmitral flow velocity EIA ratio was significantly higher in anorexia than in both the control groups because of the reduction of peak velocity A. When data from all three groups were pooled the flow velocity EIA ratio was inversely related to left atrial dimension (r = -0 43, p < 0.0001) and cardiac output (r = -0-64, p < 0.0001)

Abstract-The development of the left ventricle parallels body growth. During infancy, the relation between body size and left ventricular (LV) mass is very close. With advancing age, variability of LV mass in relation to body size markedly increases. To test the hypothesis that the age-related increase in variability of LV mass is due to the progressive impact of hemodynamic stimuli on LV growth, quantitative M-mode echocardiograms were obtained in 766 normal-weight, normotensive individuals over a range of ages from 1 day to 85 years (330 female subjects, 373 subjects younger than 18 years). LV mass was linearly related to height 2.7 (r 2 ϭ.69). Prediction of values of LV mass by body size was more accurate at birth and progressively less precise with increasing age. Stroke work (stroke volume times systolic pressure) was closely related to LV mass (r 2 ϭ.74). The explained variance of LV mass increased from 69% in the univariate regression with height 2.7 to 82% in a multivariate model including height 2.7 , stroke work, and gender. In children and adolescents (younger than 18 years), height 2.7 was the main determinant of LV mass, whereas during adulthood stroke work and gender were more important predictors of LV mass than height 2.7 . Thus (1) the influence of body growth on development of LV mass decreases after early infancy because of both the variability of hemodynamic load and the increasing effect of gender; (2) after adolescence, during adulthood, in normotensive, normal-weight individuals, the impact of hemodynamic load and male gender on LV mass is greater than the one of body size; and (3) an appreciable proportion of variability of LV mass remains unexplained with the studied models. This might be due to genotypic variations and/or measurement error. 1 during childhood and adolescence is the hallmark of this influence. However, in infancy virtually the entire variability of LV mass is explained by body size, whereas with increasing age the ability of body size to precisely predict LV mass decreases. In fact, the difference between the value of observed LV mass and that predicted from body size increases with increasing age (heteroscedastic distribution of residuals).2 This phenomenon might be explained by the progressive hemodynamic load that faces the left ventricle right after birth as the fundamental stimulus for LV muscular development. There is little information on the interaction between change in body size and in cardiac workload induced by body growth in relation to development of LV mass in large normal populations across a wide age span. Accordingly, this study has been designed to investigate the relation between the age-related increase in LV mass and the agerelated change in cardiac workload by taking into account the influence of body size during body growth and adulthood in a large study population of normotensive, normal-weight individuals. MethodsSeven hundred sixty-six normal-weight, normotensive individuals, 1 day to 85 years old, were studied in three centers: 212 men and 138...

AimsWe conducted a population-based cross-sectional study to assess the prevalence of both preclinical and clinical heart failure (HF) in the elderly. Methods and resultsA sample of 2001 subjects, 65-to 84-year-old residents in the Lazio Region (Italy), underwent physical examination, biochemistry/N-terminal pro brain natriuretic peptide (NT-proBNP) assessment, electrocardiography, and echocardiography. Systolic left ventricular dysfunction (LVD) was defined as left ventricular ejection fraction (LVEF) ,50%. Diastolic LVD was defined by a Doppler-derived multiparametric algorithm. The overall prevalence of HF was 6.7% [95% confidence interval (CI) 5.6 -7.9], mainly due to HF with preserved LVEF (HFpEF) (4.9%; 95% CI 4.0 -5.9), and did not differ by gender. A systolic asymptomatic LVD (ALVD) was detected more frequently in men (1.8%; 95% CI 1.0 -2.7) than in women (0.5%; 95% CI 0.1 -1.0; P ¼ 0.005), whereas the prevalence of diastolic ALVD was comparable between genders (men: 35.8%; 95% CI ¼ 32.7-38.9; women: 35.0%; 95% CI ¼ 31.9-38.2). The NT-proBNP levels and severity of LVD increased with age. Overall, 1623 subjects (81.1% of the entire studied population) had preclinical HF (Stage A: 22.2% and stage B: 59.1% respectively). A large number of subjects in stage B of HF showed risk factor levels not at target. ConclusionsIn a population-based study, the prevalence of preclinical HF in the elderly is high. The prevalence of clinical HF is mainly due to HFpEF and is similar between genders.--

No abstract

AimsTo test whether canrenone, an aldosterone receptor antagonist, improves left ventricular (LV) remodelling in NYHA class II heart failure (HF). Aldosterone receptor antagonists improve outcome in severe HF, but no information is available in NYHA class II. Methods and resultsAREA IN-CHF is a randomized, double-blind, placebo-controlled study testing canrenone on top of optimal treatment in NYHA class II HF with low ejection fraction (EF) to assess 12-month changes in LV end-diastolic volume (LVEDV). Brain natriuretic peptide (BNP) was also measured. Information was available for 188 subjects on canrenone and 194 on placebo. Left ventricular end-diastolic volume was similarly reduced (218%) in both arms, but EF increased more (P ¼ 0.04) in the canrenone (from 40% to 45%) than in the placebo arm (from 40-43%). Brain natriuretic peptide (n ¼ 331) decreased more in the canrenone (237%) than in the placebo arm (28%; P , 0.0001), paralleling a significant reduction in left atrial dimensions (24% vs. 0.2%; P ¼ 0.02). The composite endpoint of cardiac death and hospitalization was significantly lower in the canrenone arm (8% vs. 15%; P ¼ 0.02). ConclusionCanrenone on top of optimal treatment for HF did not have additional effects on LVEDV, but it increased EF, and reduced left atrial size and circulating BNP, with potential beneficial effects on outcome. A large-scale randomized study should be implemented to confirm benefits on cardiovascular outcomes in patients with HF in NYHA class II.--

Indices of SV and cardiac output for BSA are pertinent when the effect of obesity needs to be removed, because these indices obscure the impact of obesity. To detect the effect of obesity on LV pump function, normalization of SV and cardiac output for ideal BSA or for height to its age-specific allometric power should be practiced.

No abstract

Clinically healthy hypertensive and normotensive women have higher LV chamber and midwall systolic function than men, independent of left ventricular geometry, body size, age and heart rate. Use of gender-specific partition values to define subnormal and supranormal LV systolic function revealed that, both in hypertensive and overweight normotensive subjects, subnormal LV chamber function was uncommon, whereas stress-corrected LV chamber systolic function was frequently supranormal. Vice versa, myocardial contractility was subnormal in approximately one-sixth of asymptomatic, normotensive overweight and of hypertensive subjects, with potentially unfavorable prognostic impact.