Evaluation of left ventricular thickness and function in malnourished child

Abstract

Malnutrition is an important problem ion the third world. Cardiac complications is an important cause of mortality and morbidity among the children with poor nutrition. A case control study was done on 54 child aged 2-5 years with malnutrition attending Tikrit teaching hospital during the period from 1st of February 2007 to the 1st of February 2008 to evaluate the effect of malnutrition on the cardiothoracic ratio on plain CXR . Similar number of normal children were taken as a control with same age range during the period of the study. The total number of cases was 54 , males 37 (68.5%) and females were 17 cases (31.5%). According to the Welcome classification . most of the study cases were marasmic 22 cases (40.7%0) while the least were marasmic kwashiorkor category 8 cases (14.8%). according to the CTR in regard to the water law classification in regard to the total number of cases , most of the cases have CTR between 20-40% 27 case (50%). All the cases with mild malnutrition have normal CTR 8 cases (100%) , most of the cases with moderate malnutrition have CTR between 20-40% , 22 case (59.5%) while for the sever malnutrition , most of the cases have also CTR between 20-40% , 5 case (55.6%). according to the Welcome classification. Regarding the marasmus cases , 9 case (40.9%) have CTR between 20-40% and 8 cases (36.4%) were between 40-50%. Most of the kwashiorkor patients have CTR between 20-40 % , 8 cases (66.7%) which is similar to the marasmus kwashiorkor category 6 cases (75%0. most of the under weight patients have CTR between 40-50% , 7 cases (58.3%). In diasystole .there is significant decrease in the left ventricular wall thickness for septum 38(70.3%) and posterior wall 39(72.2%) as compared o the control cases (0%). In systole, there is significant decrease in the left ventricular thickness for septum 48(88.9%) and posterior wall 47(87%) as compared to the control cases (0%). Most of the malnutrition cases had increased heart rate 38(70.4%) as compared to the control cases 3(5.6%). There is significant decrease in the stroke volume in the malnutrition cases 44(81.5%) as compared to the control cases (0%). There is significant decrease in the cardiac output in the malnutrition cases 44 (81.5%) as compared to the control cases (0%). As well as there is significant decrease in the cardiac contractility in malnutrition cases 53 (98.1%) as compared to the control cases (0%).Regarding the fractional shortening and ejection fraction, there is significant decrease in the fractional shortening in the malnutrition cases 44 (81.5%) as compared to the control cases (0%) as well as there is significant decrease in the ejection fraction in malnutrition cases 44(81.5%) as compared to the control cases (0%). There was no significant difference regarding the left ventricular function or mass in patients with marasmus as compared to those with kwashiorkor or marasmic kwashiorkor. The study concludes that malnourished patients have smaller CTR compared with well nourished ones with significant decrease in the left ventricular thickness and function.