Echocardiographic findings of cardiac abnormalities in children and adolescents with anorexia nervosa: a systematic review

Anorexia nervosa (AN) is an eating disorder primarily affecting female adolescents and has the highest mortality rate among psychiatric disorders. Many patients with AN experience cardiovascular complications. These structural and functional cardiac changes can be detected through echocardiography. To systematically review abnormalities in the structure and function of the heart observed in echocardiography in children and adolescents with AN. We assessed the eligibility of publications from the MEDLINE database, which was last searched on November 30, 2025. Studies were included if AN was the primary eating disorder, the average age of the subjects was 18,0 or younger at the time of the study, and the study described cardiac abnormalities found with echocardiography. Non-English studies, studies not pertaining to AN, and studies where AN was not the primary disease were excluded. Two reviewers (M.W., P.W.) screened the references independently to reduce the risk of bias. Our systematic review follows PRISMA guidelines. We identified 23 eligible studies involving a total of 1246 patients. Of these, 19 studies (1181 participants) provided data suitable for systematic review. The most commonly reported structural and functional heart abnormalities in AN compared with the control group were: decreased left ventricular mass and left ventricular mass indexed to body surface area (15/19 studies), left ventricular systolic and diastolic dysfunction (11/19), valvular abnormalities (4/19), and an increased incidence of pericardial effusion (9/19). Four studies compared diagnostic subgroups of AN, mainly restricting type (AN-R) and binge-eating/purging type (AN-BP). One study compared echocardiographic abnormalities between patients with hyperactive (ANH+) and non-hyperactive (ANH-) types of AN. Six studies documented the resolution of symptoms in some patients following weight restoration. Analyzed studies suggest that patients with AN may be at increased risk for cardiovascular disease. Many studies had small sample sizes, and some had a low to moderate risk of bias. Further research with larger sample sizes is recommended. All but one of the research papers included come from high-income countries, which limits external validity. The experience of the person performing the echocardiography, potential feedback from the supervisor, the anatomical conditions of the patient, and the patient’s willingness to cooperate may also impact the reliability of the studies included in this review. This research received no specific funding from any public, commercial, or non-profit organization. The authors declare no conflicts of interest. Anorexia nervosa (AN) is a serious eating disorder that primarily affects female adolescents and carries a high risk of life-threatening cardiovascular complications. We systematically reviewed 19 studies involving 1,181 children and teenagers to see how severe starvation changes the heart's structure and function via echocardiography. Our findings showed that patients with AN frequently experience a decrease in the overall mass and weight of the left ventricle, a lower volume of blood pumped with each beat and an abnormal buildup of fluid in the sac surrounding the heart. Some patients developed minor valve problems, most commonly mitral valve prolapse. The data revealed that these changes are tied to low body weight and can be reversed: when young patients undergo weight restoration and nutritional recovery, their heart muscle grows back toward a normal size, its pumping capacity improves, and the fluid surrounding the heart typically disappears. These results provide baseline data that can help clinicians distinguish standard adaptations to starvation from dangerous medical emergencies, ensuring that high-risk pediatric patients receive the right cardiac monitoring and care during their recovery.