Thursday, July 3, 2014

Cardiac MRI and CFS

Source: University of Twente, The Netherlands
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

Tuesday, July 1, 2014

Proof of Abnormal Response to Exercise in CFS

Exerc Immunol Rev. 2014;20:94-116.
Altered immune response to exercise in patients with chronic fatigue
syndrome/myalgic encephalomyelitis: a systematic literature review.
Nijs J, Nees A, Paul L, De Kooning M, Ickmans K, Meeus M, Van Oosterwijck J.


An increasing number of studies have examined how the immune system of
patients with Chronic Fatigue Syndrome (CFS), or myalgic
encephalomyelitis, responds to exercise. The objective of the present
study was to systematically review the scientific literature
addressing exercise-induced immunological changes in CFS patients
compared to healthy control subjects. A systematic literature search
was conducted in the PubMed and Web of science databases using
different keyword combinations. We included 23 case control studies
that examined whether CFS patients, compared to healthy sedentary
controls, have a different immune response to exercise. The included
articles were evaluated on their methodological quality. Compared to
the normal response of the immune system to exercise as seen in
healthy subjects, patients with CFS have a more pronounced response in
the complement system (i.e. C4a split product levels), oxidative
stress system (i.e. enhanced oxidative stress combined with a delayed
and reduced anti-oxidant response), and an alteration in the immune
cells' gene expression profile (increases in post-exercise
interleukin-10 and toll-like receptor 4 gene expression), but not in
circulating pro- or anti-inflammatory cytokines. Many of these immune
changes relate to post-exertional malaise in CFS, a major
characteristic of the illness.
The literature review provides level B
evidence for an altered immune response to exercise in patients with

PMID: 24974723 [PubMed - in process] name change

Old: The CFIDS Association of America

New: Solve ME/CFS Initiative
Newsletters: * Research 1st News
* Solve CFS Chronicle