Purpose: In chronic fatigue syndrome (CFS), only a few imaging and histopathological studies previously assessed either cardiac dimensions/function or myocardial tissue, suggesting smaller left ventricular (LV) dimensions, LV wall motion abnormalities (WMA), and occasionally viral persistence that may lead to cardiomyopathy. The present CMR study is the first to use a combined approach to assess cardiac involvement in CFS patients.

Methods: In a consecutive series of 12 female CFS patients, CMR measurements were compared with 36 age-matched, female controls. With cine images, LV volumes, ejection fraction (EF), mass, and WMA were assessed. T2-weighted images were analyzed for increased signal intensity, reflecting edema (i.e. inflammation). Presence of CE, reflecting fibrosis (i.e. myocardial damage), was also analyzed.

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

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

Combined Cardiac Magnetic Resonance Imaging of cardiac dimensions,left ventricular function, and myocardial tissue characteristics in female patients with chronic fatigue syndrome, by MA Olimulder et al in Ph.D. Thesis Marlon Olimulder, Chapter 8.

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