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Chronic fatigue syndrome in women assessed with combined cardiac magnetic resonance imaging

View Article: PubMed Central - PubMed

ABSTRACT

Objective: In chronic fatigue syndrome (CFS), only a few imaging and histopathological studies have previously assessed either cardiac dimensions/function or myocardial tissue, suggesting smaller left ventricular (LV) dimensions, LV wall motion abnormalities and occasionally viral persistence that may lead to cardiomyopathy. The present study with cardiac magnetic resonance (CMR) imaging is the first to use a contrast-enhanced approach to assess cardiac involvement, including tissue characterisation of the LV wall.

Methods: CMR measurements of 12 female CFS patients were compared with data of 36 age-matched, healthy female controls. With cine imaging, LV volumes, ejection fraction (EF), mass, and wall motion abnormalities were assessed. T2-weighted images were analysed for increased signal intensity, reflecting oedema (i. e. inflammation). In addition, the presence of contrast enhancement, reflecting fibrosis (i. e. myocardial damage), was analysed.

Results: When comparing CFS patients and healthy controls, LVEF (57.9 ± 4.3 % vs. 63.7 ± 3.7 %; p < 0.01), end-diastolic diameter (44 ± 3.7 mm vs. 49 ± 3.7 mm; p < 0.01), as well as body surface area corrected LV end-diastolic volume (77.5 ± 6.2 ml/m2 vs. 86.0 ± 9.3 ml/m2; p < 0.01), stroke volume (44.9 ± 4.5 ml/m2 vs. 54.9 ± 6.3 ml/m2; p < 0.001), and mass (39.8 ± 6.5 g/m2 vs. 49.6 ± 7.1 g/m2; p = 0.02) were significantly lower in patients. Wall motion abnormalities were observed in four patients and contrast enhancement (fibrosis) in three; none of the controls showed wall motion abnormalities or contrast enhancement. None of the patients or controls showed increased signal intensity on the T2-weighted images.

Conclusion: In patients with CFS, CMR demonstrated lower LV dimensions and a mildly reduced LV function. The presence of myocardial fibrosis in some CFS patients suggests that CMR assessment of cardiac involvement is warranted as part of the scientific exploration, which may imply serial non-invasive examinations.

No MeSH data available.


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CMR findings in patient with chronic fatigue syndrome. Patient 1. a T2-weighted CMR imaging short-axis view; no presence of increased signal intensity was observed. b, c, d Contrast-enhanced-CMR imaging short-axis view, four-chamber view and two-chamber view; arrow demonstrates midwall contrast enhancement in the basal inferoseptal, septal and anteroseptal segments
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Fig1: CMR findings in patient with chronic fatigue syndrome. Patient 1. a T2-weighted CMR imaging short-axis view; no presence of increased signal intensity was observed. b, c, d Contrast-enhanced-CMR imaging short-axis view, four-chamber view and two-chamber view; arrow demonstrates midwall contrast enhancement in the basal inferoseptal, septal and anteroseptal segments

Mentions: The complete CMR examination protocol was followed in all CFS patients and controls; image sequences of a high quality could be obtained in all cases. CMR data of our CFS population are presented in Table 2. In CFS patients, LVEF (57.9 ± 4.3 %; p < 0.01), end-diastolic diameter (44 ± 3.7), as well as body surface area corrected end-diastolic LV volume (77.5 ± 6.2 ml/m2; p < 0.01), LV stroke volume (44.9 ± 4.5 ml/m2; p < 0.001), and LV wall mass (39.8 ± 6.5 g/m2; p = 0.02) were significantly lower than age- and gender-matched controls. Mild wall motion abnormalities were observed in four CFS patients in the basal and/or mid inferoseptal wall, leading to a wall motion score index of 0.02 ± 0.04; none of the controls showed wall motion abnormalities. Myocardial damage (i. e. fibrosis), as indicated by the presence of contrast enhancement, was observed in three patients who showed such lesions in the basal inferoseptal, septal, and anteroseptal midwall segments. An example is presented in Fig. 1. No contrast enhancement was seen in healthy controls. Only one patient showed both contrast enhancement and wall motion abnormalities. Regional or global oedema, as indicated by an increased signal intensity on T2-weighted images, was not observed in any of the patients.Table 2


Chronic fatigue syndrome in women assessed with combined cardiac magnetic resonance imaging
CMR findings in patient with chronic fatigue syndrome. Patient 1. a T2-weighted CMR imaging short-axis view; no presence of increased signal intensity was observed. b, c, d Contrast-enhanced-CMR imaging short-axis view, four-chamber view and two-chamber view; arrow demonstrates midwall contrast enhancement in the basal inferoseptal, septal and anteroseptal segments
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5120006&req=5

Fig1: CMR findings in patient with chronic fatigue syndrome. Patient 1. a T2-weighted CMR imaging short-axis view; no presence of increased signal intensity was observed. b, c, d Contrast-enhanced-CMR imaging short-axis view, four-chamber view and two-chamber view; arrow demonstrates midwall contrast enhancement in the basal inferoseptal, septal and anteroseptal segments
Mentions: The complete CMR examination protocol was followed in all CFS patients and controls; image sequences of a high quality could be obtained in all cases. CMR data of our CFS population are presented in Table 2. In CFS patients, LVEF (57.9 ± 4.3 %; p < 0.01), end-diastolic diameter (44 ± 3.7), as well as body surface area corrected end-diastolic LV volume (77.5 ± 6.2 ml/m2; p < 0.01), LV stroke volume (44.9 ± 4.5 ml/m2; p < 0.001), and LV wall mass (39.8 ± 6.5 g/m2; p = 0.02) were significantly lower than age- and gender-matched controls. Mild wall motion abnormalities were observed in four CFS patients in the basal and/or mid inferoseptal wall, leading to a wall motion score index of 0.02 ± 0.04; none of the controls showed wall motion abnormalities. Myocardial damage (i. e. fibrosis), as indicated by the presence of contrast enhancement, was observed in three patients who showed such lesions in the basal inferoseptal, septal, and anteroseptal midwall segments. An example is presented in Fig. 1. No contrast enhancement was seen in healthy controls. Only one patient showed both contrast enhancement and wall motion abnormalities. Regional or global oedema, as indicated by an increased signal intensity on T2-weighted images, was not observed in any of the patients.Table 2

View Article: PubMed Central - PubMed

ABSTRACT

Objective: In chronic fatigue syndrome (CFS), only a&nbsp;few imaging and histopathological studies have previously assessed either cardiac dimensions/function or myocardial tissue, suggesting smaller left ventricular (LV) dimensions, LV wall motion abnormalities and occasionally viral persistence that may lead to cardiomyopathy. The present study with cardiac magnetic resonance (CMR) imaging is the first to use a&nbsp;contrast-enhanced approach to assess cardiac involvement, including tissue characterisation of the LV wall.

Methods: CMR measurements of 12&nbsp;female CFS patients were compared with data of 36 age-matched, healthy female controls. With cine imaging, LV volumes, ejection fraction (EF), mass, and wall motion abnormalities were assessed. T2-weighted images were analysed for increased signal intensity, reflecting oedema (i.&thinsp;e. inflammation). In addition, the presence of contrast enhancement, reflecting fibrosis (i.&thinsp;e. myocardial damage), was analysed.

Results: When comparing CFS patients and healthy controls, LVEF (57.9&nbsp;&plusmn; 4.3&thinsp;% vs. 63.7&nbsp;&plusmn; 3.7&thinsp;%; p&nbsp;&lt; 0.01), end-diastolic diameter (44&nbsp;&plusmn; 3.7&nbsp;mm vs. 49&nbsp;&plusmn; 3.7&nbsp;mm; p&nbsp;&lt; 0.01), as well as body surface area corrected LV end-diastolic volume (77.5&nbsp;&plusmn; 6.2&nbsp;ml/m2 vs. 86.0&nbsp;&plusmn; 9.3&nbsp;ml/m2; p&nbsp;&lt; 0.01), stroke volume (44.9&nbsp;&plusmn; 4.5&nbsp;ml/m2 vs. 54.9&nbsp;&plusmn; 6.3&nbsp;ml/m2; p&nbsp;&lt; 0.001), and mass (39.8&nbsp;&plusmn; 6.5&nbsp;g/m2 vs. 49.6&nbsp;&plusmn; 7.1&nbsp;g/m2; p&nbsp;= 0.02) were significantly lower in patients. Wall motion abnormalities were observed in four patients and contrast enhancement (fibrosis) in three; none of the controls showed wall motion abnormalities or contrast enhancement. None of the patients or controls showed increased signal intensity on the T2-weighted images.

Conclusion: In patients with CFS, CMR demonstrated lower LV dimensions and a&nbsp;mildly reduced LV function. The presence of myocardial fibrosis in some CFS patients suggests that CMR assessment of cardiac involvement is warranted as part of the scientific exploration, which may imply serial non-invasive examinations.

No MeSH data available.


Related in: MedlinePlus