DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20161429

Myocardial performance index in severe acute malnutrition children aged 6 month to 5 years

Reeta Meena, Rameshwar Lal Suman, Pradeep Meena, Shiv Lal Meena

Abstract


Background:Severe Acute Malnutrition (SAM) is one of the most common health problems. Children suffering from SAM frequently exhibit cardiovascular abnormalities leading to morbidity and mortality. We evaluated myocardial performance index (MPI) to measure both systolic and diastolic functions of the heart.

Methods: Hospital based prospective study in which we enrolled 100 children with SAM aged 6 months to 5 years admitted in malnutrition treatment centre (MTC), Bal Chikitaslya, Udaipur, Rajasthan, India. All the children underwent a detailed clinical and echocardiographic evaluation. The different echocardiographic variables along with MPI were calculated.

Results:Out of 100 children majority of study population was in <-3SD, Z-score and <-4 SD, Z-score (63%), although extremes like <-5 SD to <-7SD, Z-score were also noted in 35% of children. In echocardigraphic variables ventricular function as mean ejection fraction was normal (70.69±9.57). The mean MPI was 0.41±0.11 with p-value of <0.001.

Conclusions:MPI in SAM children was abnormally high inspite of normal ejection fraction. This can be used in children with SAM as early marker of ventricular dysfunction even before ejection fraction starts declining.  


Keywords


Echocardiography, Myocardial performance index, Severe acute malnutrition, WHO SD Z-score

Full Text:

PDF

References


Sachdev HPS, Kapil U and Sheila V. Consensus Statement: national consensus workshop on management of SAM Children through medical nutrition therapy. Indian Pediatrics, 2010;47:651-4.

International Institute for population sciences. National family health survey 3, (2005-2006). Mumbai India: International Institute of Population Science; 2006.

Phornphatkul C, Pongprot Y, Suskind R, George V, Fuchs G. Cardiac function in malnourished children. Clin Pediatr. 1994;33(3):147-55.

McLaren DS. Protein energy malnutrition (PEM): classification, pathogenesis, prevalence, prevention. In McLaren DS, Burman D, eds. Textbook of Pediatric Nutrition. Churchill Livingstone, Edinburgh;1982:103-113.

Gelb BD, Abdenur J. Metabolic heart disease. In Garson A, Bricker TJ, Fisher DJ, Neish JR, eds. The Science and Practice of Pediatric Cardiology, 2nd edition. Williams and Wilkins, Baltimore; 1998:1913.

Heymsfield SR, Bethel RA, Ansley JD, Gibbs DM, Felner JM, Nutter DO. Cardiac abnormalities in cachectic patients before and during nutritional repletion. Am Heart J. 1978;95(5):584-94.

Chase HP, Kumar V, Caldwell RT, O’Brien D. Kwashiorkor in the United States. Pediatrics. 1980;66:972-6.

Bergman JW, Human DG, De MMA, Schultz JM. Effect of kwashiorkor on the cardiovascular system. Arch Dis Child. 1988;63:1359-62.

Singh GR, Malathi KE, Kasliwal RR, Ommar A, Padmavati S, Ramji S. An evaluation of cardiac function in malnourished children by non-invasive methods. Indian Paediatrics. 1989;26:875-80.

Benjamin WE, Frank C, Patrick WO. Echocardiography in pediatric and adult congenital heart disease: quantative methods in echocardiography- basic technique. 1st edition. Lippincott. Williams and Wilkins;2009:31-32.

Tei C, Dujardin K, Hodge D. Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis. J Am Coll Cardiol. 1996;28:658-64.

Tei C, Dujardin K, Hodge D, Bailey KR, McGoon MD, Tajik AJ,et al. Doppler echocardiographic index for assessment of global right ventricular function. J Am Soc Echocardiogr. 1996;9(6):838-47.

Ocal B, Oguz O, Karademir S, Birgen D, Yuksek N, Ertem U, et al. Myocardial performance index combining systolic and diastolic myocardial performance in doxorubicin treated patients and its correlation to conventional echo/ Doppler indices. Pediatr Cardiol. 2002;23(5):522-7.

Nearchou N, Tsakiris A, Stathakopoulos D. A new doppler index combining systolic and diastolic myocardial performance. Behaviour and significance during hospitalization of patients with acute myocardial infarction. Hellenic J Cardiol. 1999;40:486-96.

Borzoee M, Kheirandish Z. Doppler derived Myocardial performance index in Healthy Children in Shiraz. Ind J Med Sci. 2004;29(2):85-9.