Date: June 25, 2014
Ref: Ph.D. Thesis Marlon Olimulder, Chapter 8.
Combined Cardiac Magnetic Resonance Imaging of cardiac
dimensions, left ventricular function, and myocardial tissue
characteristics in female patients with chronic fatigue syndrome
Olimulder MA, Galjee MA, Wagenaar LJ, van Es J, van der Palen J,
Visser FC, Vermeulen RC, von Birgelen C.
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.
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.
When comparing CFS patients and controls, LVEF (57.9 p/m 4.3% vs. 63.7
p/m 3.7%; p<0.01), end-diastolic diameter (44 p/m 3.7mm vs. 49 p/m
3.7mm; p<0.01), as well as body surface area (BSA)-corrected LV
end-diastolic volume (77.5 p/m 6.2ml/m2 vs. 86.0 p/m 9.3ml/m2;
p<0.01), LV stroke volume (44.9 p/m 4.5ml/m2 vs. 54.9 p/m 6.3ml/m2;
p<0.001), and LV mass (39.8 p/m 6.5g/m2 vs. 49.6 p/m 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.
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.
(c) 2014 University of Twente