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Myocardial dysfunction in malnourished children

Nagla Hassan ABUFADDAN, Khalid Ibrahim EL SAYH, Hamdy SHAMS, Hosni BADRAWY
3.815 844


Background: Malnourished children suffer several alterations in body composition that could produce cardiac abnormalities. Measurement of cardiac troponin T (cTnT) in blood is considered one of the gold standers for detecting heart damage and not only used as an indicator of myocardial damage but also for prognostic information.
The aim of this study was to detect the frequency of myocardial damage as shown by echocardiography and cTnT level in malnourished children.
Patients and methods: The current study included 45 malnourished infants and young children (25 male and 20 female) with a mean age 11.24 ± 7.88 months, as well as 25 apparently healthy age and sex matched children (11 male and 13 female) with a mean age 10.78± 6.29 months as a control group. Complete blood picture, serum albumin, liver and kidney function tests, serum sodium, potassium and calcium level, cardiac troponin T and echocardiographic evaluation were done for cases and controls.
Results: The results of the present study revealed a significantly lower left ventricular (LV) mass in patients than the control group, and the left ventricular mass index (LVMI) was correlated positively with the body mass index (BMI). In patients with third degree marasmus (M III), kwashiorkor (KWO) marasmic-kwashiorkor (M-KWO) the LV systolic functions were significantly impaired in comparison to controls. cTnT levels were higher than the upper reference limits in 11 (24.44 %) of the studied children with PEM, all of them had severe degree of malnutrition, 6 (54.5%) of them had marasmus third degree, 2 (18%) of them had kwashiorkor (KWO) and 3 (27.7%) had marasmic-kwashiorkor (M-KWO). cTnT level was significantly higher in patients with anemia, sepsis, electrolyte deficiency and it correlated negatively to LVEF. Six (54.5%) of studied children with high cTnT levels died within 21 days of treatment compared to one (2.9%) of those with baseline levels.
Conclusion: LV mass are reduced in malnourished children in proportion to the decrease in body size. Children with M III, KWO and M-KWO not only have cardiac muscle wasting, but also have a significant decrease in LV systolic functions. Elevated cardiac troponin level in malnourished children has both diagnostic and prognostic significance for cardiomyocyte damage.


Protein Energy Malnutrition, echocardiography, cTnT

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