Tissue doppler examination of left ventricular mechanics in adolescent followed with the diagnosis of cachexia and evaluation of clinical relationships with insulin resistance

Objectives: Malnutrition is one of the common diseases in childhood. Children with malnutrition experience the involvement of various systems, including the gastrointestinal, endocrine, neurological, immune, respiratory, and cardiovascular systems. Cardiac abnormal findings such as hypotension, cardiac arrhythmias, diastolic dysfunction, heart failure, and sudden death are observed in malnourished children, along with changes in other body systems. Cachexia is a complex metabolic syndrome characterized by weight loss due to proinflammatory cytokines related to any chronic illness. Thinness is a new term in the literature. Thinness refers to an individual's body mass index (BMI) being between -2 SDS and -3 SDS without the presence of chronic illness. The aim of this study is to examine the electrocardiographic, echocardiographic, biochemical parameters, and exercise capacities of underweight and severely underweight child patients aged 13-18, and to evaluate the correlation with insulin resistance. Methods: The study included 25 patients (15 females, 10 males, 60%, and 40%, respectively) aged 13-18 with Body Mass İndex (BMI) <-2 SDS and without any chronic diseases. Patients were included based on clinical data such as height, weight, BMI, age, and gender. Patients with BMI<(- 2) (-3) SDS are called thinness, and patients with BMI< -3 SDS are called severe thinness. Previously conducted tests, including serum glucose, insulin, lipids, ALT, creatinine, Pro-BNP, troponin, CK-MB, along with M-mode and tissue Doppler echocardiographies performed by a single expert, 24-hour ambulatory holter rhythms, and exercise stress test results, were included. BMI and HOMA-IR and cardiac examination findings of the patients in the study group were compared. Results: A total of 25 patients aged 13-18 with BMI <-2 SDS were included in the study. 60% of the patients were female, and 40% were male. HOMA-IR, showed insulin resistance in 28% (7 patients, 6F, 1M) of our study population. When compared within our study group regarding insulin resistance in tinness and severe tinness patients, significantly higher insulin resistance was observed in the severe tinness group. ( HOMA IR mean 6.04 vs 1.64, p = 0.004) According to our findings, Left Ventricle Ejexion Fraction (LVEF) and fraxionel shortening (FS) were normal limits in all patient. Howewer decreased in Left Ventricle End Diastolic Volume (LVEDV) (n=3, 12%), LV Mass Diastolic (n=9, 36%) were observed in 3 (12%) and in 9 (36%) case. No significant correlation was found between LV mass Diastolic, LV mass Systolic, and BMI (r = 0.13, p = 0.55; r = 0.22, p = 0.36, respectively). Although the correlation between LV MPI and BMI was examined within the scope of our research objectives, no significant result was observed (r = 0.03, p = 0.92), but there is a significant correlation between insulin resistance and LV MPI (r = 0.44, p = 0.08). No significant relationships were observed in our findings between BMI (r = -0.08, p = 0.70) and insulin resistance (r = -0.27, p = 0.26) with right ventricular dysfunction. When the tissue Doppler echocardiography data of thinness and severely thinness patients were compared, the LV lateral ventricular A-wave velocity of thinness patients was significantly higher than that of severe thinness patients (p<0.05). SVE was detected in 31.6% (6 patients), ST-T variability in 15.8% (3 patients), and VES in 15.8% (3 patients). Only one of the patients with SVE had 10% SVE, and other patients were interpreted as having rare SVE. In patients with VES, all were found to have rare VES. However, these findings related to SVE and VES are consistent with those in the normal population. According to heart rate variability data, 21.1% (4 patients) had pNN50<15, 5.2% (1 patient) had RMSSD<25, and 21.1% (4 patients) had a triangular index<30. Conclusions: We found 28% insulin resistance in the study group, with the severe thinness group showing more resistance than the thinness group. There was a significant link between left ventricular diastolic dysfunction and insulin resistance, but none with BMI and diastolic or systolic functions. The LV lateral ventricular A-wave velocity was higher in the thinness group. Heart rate variability data showed 21% had pNN50<15, 5.2% had RMSSD<25, and 21.1% had a triangular index<30. The study links insulin resistance with left ventricular diastolic dysfunction, requiring further study. Monitoring echocardiography and biochemical parameters are necessary for thinness patients.