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

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/m(2) vs. 86.0 ±  9.3 ml/m(2); p < 0.01), stroke volume (44.9 ± 4.5 ml/m(2) vs. 54.9 ± 6.3 ml/m(2);  p < 0.001), and mass (39.8 ± 6.5 g/m(2) vs. 49.6 ± 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.