Research 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 p/m 4.3 % vs. 63.7 p/m 3.7 %; p<0.01), end-diastolic diameter (44 p/m 3.7 mm vs. 49 p/m 3.7 mm; p<0.01), as well as body surface area corrected LV end-diastolic volume (77.5 p/m 6.2 ml/m^2 vs. 86.0 p/m 9.3 ml/m^2; p<0.01), stroke volume (44.9 p/m 4.5 ml/m^2 vs. 54.9 p/m 6.3 ml/m^2; p<0.001), and mass (39.8 p/m 6.5 g/m^2 vs. 49.6 p/m 7.1 g/m^2; 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.

Chronic fatigue syndrome in women assessed with combined cardiac magnetic resonance imaging, by M.A.G.M. Olimulder, M.A. Galjee, L.J. Wagenaar, J. van Es, J. van der Palen, F.C. Visser, R.C.W. Vermeulen, C. von Birgelen in Netherlands Heart Journal [Preprint]
August 25, 2016