[Mitral valve prolapse is a frequent cardiovascular finding in patients with anorexia nervosa].

I read with interest the recent article on cardiac disorders in young women with anorexia nervosa by Vázquez et al.1 I was surprised, however, that the authors made no mention of mitral valve prolapse. The association of mitral valve prolapse with anorexia nervosa has been known for a long time.2-9 Taking into account the pathophysiology of mitral valve prolapse makes it easy to understand this frequent finding. According to the valvular-ventricular disproportion theory10,11 mitral valve prolapse results from either excessive mitral valve tissue or inadequate left ventricular cavity size. Left ventricular cavity size is reduced in anorexia nervosa.12 The finding that mitral valve prolapse disappeared in patients with anorexia nervosa after they received appropriate therapy and gained weight but recurred during follow-up in those patients who lost weight again2 is further support to this theory. Aggressive nutritional replenishment or even forced feeding is therefore important for the management of patients with anorexia nervosa, not only for the anorexia itself but also for the associated mitral valve prolapse.3 One of the complications of mitral valve prolapse is sudden death,11,13 therefore mitral valve prolapse may play a role in sudden death in some patients with anorexia nervosa. Although sudden death in anorexia nervosa may be due to prolonged QT interval and QT dispersion as Vázquez et al1 suggested, it may also be secondary to the associated mitral valve prolapse.11,14-18 Therefore, if for no other reason than to prevent mitral valve prolapse and sudden death, the therapeutic efforts in anorexia nervosa should be concentrated on those that result in weight gain.4