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Erschienen in: Heart and Vessels 4/2015

01.07.2015 | Original Article

Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle

verfasst von: Kunihisa Miwa

Erschienen in: Heart and Vessels | Ausgabe 4/2015

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Abstract

The etiology of chronic fatigue syndrome (CFS) is unknown. Myalgic encephalomyelitis (ME) has been recently postulated to be the cause of CFS. Orthostatic intolerance (OI) has been known as an important symptom in predicting quality of life in CFS patients. Cardiac function may be impaired in patients with ME. The presence or absence of OI was determined both symptomatically and by using a 10-min stand-up test in 40 ME patients. Left ventricular (LV) dimensions and function were determined echocardiographically in the ME patients compared to 40 control subjects. OI was noted in 35 (97 %) of the 36 ME patients who could stand up quickly. The mean values for the cardiothoracic ratio, systemic systolic and diastolic pressures, LV end-diastolic diameter (EDD), LV end-systolic diameter, stroke volume index, cardiac index and LV mass index were all significantly smaller in the ME group than in the controls. Both a small LVEDD (<40 mm, 45 vs. 3 %) and a low cardiac index (<2 l/min/mm2, 53 vs. 8 %) were significantly more common in the ME group than in the controls. Both heart rate and LV ejection fraction were similar between the groups. In conclusion, a small LV size with a low cardiac output was common in ME patients, in whom OI was extremely common. Cardiac dysfunction with a small heart appears to be related to the symptoms of ME.
Literatur
2.
Zurück zum Zitat Fukuda K, Straus SE, Hickle I, Sharpe Mc, Dobbins JG, Komaroff A, International Chronic Fatigue Syndrome Study Group (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Int Med 121:953–959PubMedCrossRef Fukuda K, Straus SE, Hickle I, Sharpe Mc, Dobbins JG, Komaroff A, International Chronic Fatigue Syndrome Study Group (1994) The chronic fatigue syndrome: a comprehensive approach to its definition and study. Ann Int Med 121:953–959PubMedCrossRef
3.
4.
Zurück zum Zitat Carruthers BM, van de Sande MI, De Meirleir KL, Klimas NG, Broderick G, Mitchell T, Staines D, Powles ACP, Speight N, Vallings R, Bateman L, Baumgarten-Austrheim B, Bell DS, Carlo-Stella N, Chia J, Darragh A, Jo D, Lewis D, Light AR, Marshall-Gradisbik S, Mena I, Mikovits JA, Miwa K, Murovska M, Pall ML, Stevens S (2011) Myalgic encephalomyelitis: international Consensus Criteria. J Int Med 270:327–338CrossRef Carruthers BM, van de Sande MI, De Meirleir KL, Klimas NG, Broderick G, Mitchell T, Staines D, Powles ACP, Speight N, Vallings R, Bateman L, Baumgarten-Austrheim B, Bell DS, Carlo-Stella N, Chia J, Darragh A, Jo D, Lewis D, Light AR, Marshall-Gradisbik S, Mena I, Mikovits JA, Miwa K, Murovska M, Pall ML, Stevens S (2011) Myalgic encephalomyelitis: international Consensus Criteria. J Int Med 270:327–338CrossRef
5.
Zurück zum Zitat Schondorf R, Freeman R (1999) The importance of orthostatic intolerance in the chronic fatigue syndrome. Am J Med Sci 317:117–123PubMedCrossRef Schondorf R, Freeman R (1999) The importance of orthostatic intolerance in the chronic fatigue syndrome. Am J Med Sci 317:117–123PubMedCrossRef
6.
Zurück zum Zitat Schondorf R, Benoit J, Wein T, Phaneuf D (1999) Orthostatic intolerance in the chronic fatigue syndrome. J Auton Nerv Syst 75:192–201PubMedCrossRef Schondorf R, Benoit J, Wein T, Phaneuf D (1999) Orthostatic intolerance in the chronic fatigue syndrome. J Auton Nerv Syst 75:192–201PubMedCrossRef
7.
Zurück zum Zitat Streeten DHP, Thomas D, Bell DS (2000) The roles of orthostatic hypotension, orthostatic tachycardia, and subnormal erythrocyte volume in the pathogenesis of the chronic fatigue syndrome. Am J Med Sci 320:1–8PubMedCrossRef Streeten DHP, Thomas D, Bell DS (2000) The roles of orthostatic hypotension, orthostatic tachycardia, and subnormal erythrocyte volume in the pathogenesis of the chronic fatigue syndrome. Am J Med Sci 320:1–8PubMedCrossRef
8.
Zurück zum Zitat Costigan A, Elliott C, McDonaldo C, Newton JL (2010) Orthostatic symptoms predict functional capacity in chronic fatigue syndrome: implications for management. Q J Med 103:589–595CrossRef Costigan A, Elliott C, McDonaldo C, Newton JL (2010) Orthostatic symptoms predict functional capacity in chronic fatigue syndrome: implications for management. Q J Med 103:589–595CrossRef
9.
Zurück zum Zitat Miwa K, Fujita M (2008) “Small heart syndrome” in patients with chronic fatigue syndrome. Clin Cardiol 31:328–333PubMedCrossRef Miwa K, Fujita M (2008) “Small heart syndrome” in patients with chronic fatigue syndrome. Clin Cardiol 31:328–333PubMedCrossRef
10.
Zurück zum Zitat Miwa K, Fujita M (2009) Cardiac function fluctuates during exacerbation and remission in young adults with chronic fatigue syndrome and “small heart”. J Cardiol 54:29–35PubMedCrossRef Miwa K, Fujita M (2009) Cardiac function fluctuates during exacerbation and remission in young adults with chronic fatigue syndrome and “small heart”. J Cardiol 54:29–35PubMedCrossRef
11.
Zurück zum Zitat Miwa K, Fujita M (2009) Cardiovascular dysfunction with low cardiac output due to small heart in patients with chronic fatigue syndrome. Inter Med 48:1849–1854CrossRef Miwa K, Fujita M (2009) Cardiovascular dysfunction with low cardiac output due to small heart in patients with chronic fatigue syndrome. Inter Med 48:1849–1854CrossRef
12.
Zurück zum Zitat Miwa K, Fujita M (2011) Small heart with low cardiac output for orthostatic intolerance in patients with chronic fatigue syndrome. Clin Cardiol 34:782–786PubMedCrossRef Miwa K, Fujita M (2011) Small heart with low cardiac output for orthostatic intolerance in patients with chronic fatigue syndrome. Clin Cardiol 34:782–786PubMedCrossRef
13.
Zurück zum Zitat Fu Q, VanGundy TB, Galbreath M, Shibata S, Jain M, Hastings JL, Bhella PS, Levine BD (2010) Cardiac origins of the postural orthostatic tachycardia syndrome. J Am Coll Cardiol 55:2858–2868PubMedCentralPubMedCrossRef Fu Q, VanGundy TB, Galbreath M, Shibata S, Jain M, Hastings JL, Bhella PS, Levine BD (2010) Cardiac origins of the postural orthostatic tachycardia syndrome. J Am Coll Cardiol 55:2858–2868PubMedCentralPubMedCrossRef
14.
Zurück zum Zitat Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgeseaell H, Reichek N, Sahn D, Schnittinger I, Silverman N, Tajik J, the American Society of Echocardiography, Committee on Standards, Subcommittee on Quantification of Two-Dimensional Echocardiograms (1989) Recommendations for the quantification of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 2:358–367PubMedCrossRef Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgeseaell H, Reichek N, Sahn D, Schnittinger I, Silverman N, Tajik J, the American Society of Echocardiography, Committee on Standards, Subcommittee on Quantification of Two-Dimensional Echocardiograms (1989) Recommendations for the quantification of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 2:358–367PubMedCrossRef
15.
Zurück zum Zitat Teichholz LE, Kreulen T, Herman MV, Gorlin R (1976) Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy. Am J Cardiol 37:7–11PubMedCrossRef Teichholz LE, Kreulen T, Herman MV, Gorlin R (1976) Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence or absence of asynergy. Am J Cardiol 37:7–11PubMedCrossRef
16.
Zurück zum Zitat Peckerman A, Lamanca JJ, Dahl KA, Chemitiganti R, Qureishi B, Natelson BH (2003) Abnormal impedance cardiography predicts symptom severity in chronic fatigue syndrome. Am J Med Sci 326:55–60PubMedCrossRef Peckerman A, Lamanca JJ, Dahl KA, Chemitiganti R, Qureishi B, Natelson BH (2003) Abnormal impedance cardiography predicts symptom severity in chronic fatigue syndrome. Am J Med Sci 326:55–60PubMedCrossRef
17.
Zurück zum Zitat Hurwitz BE, Coryell VT, Parker M, Martin P, LaPerriere A, Kilmas NG, Sfakianakis GN, Bilsker MS (2010) Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function. Clin Sci 118:125–135CrossRef Hurwitz BE, Coryell VT, Parker M, Martin P, LaPerriere A, Kilmas NG, Sfakianakis GN, Bilsker MS (2010) Chronic fatigue syndrome: illness severity, sedentary lifestyle, blood volume and evidence of diminished cardiac function. Clin Sci 118:125–135CrossRef
18.
Zurück zum Zitat Hattori H, Minami Y, Mizuno M, Yumino D, Hoshi H, Arashi H, Nuki T, Sashida Y, Higashitani M, Serizawa N (2013) Differences in hemodynamic responses between intravenous carperitide and nicorandil in patients with acute heart failure syndromes. Heart Vessels 28:345–351PubMedCrossRef Hattori H, Minami Y, Mizuno M, Yumino D, Hoshi H, Arashi H, Nuki T, Sashida Y, Higashitani M, Serizawa N (2013) Differences in hemodynamic responses between intravenous carperitide and nicorandil in patients with acute heart failure syndromes. Heart Vessels 28:345–351PubMedCrossRef
19.
Zurück zum Zitat Ehara H, Nakamura Y, Matsumoto K, Hasegawa T, Shimada K, Takagi M, Hanatani A, Izumi Y, Terashima M, Yoshiyama M (2013) Effects of intravenous atrial natriuretic peptide and nitroglycerin on coronary vasodilation and flow velocity determined using 3 T magnetic resonance imaging in patients with nonischemic heart failure. Heart Vessels 28:596–605PubMedCrossRef Ehara H, Nakamura Y, Matsumoto K, Hasegawa T, Shimada K, Takagi M, Hanatani A, Izumi Y, Terashima M, Yoshiyama M (2013) Effects of intravenous atrial natriuretic peptide and nitroglycerin on coronary vasodilation and flow velocity determined using 3 T magnetic resonance imaging in patients with nonischemic heart failure. Heart Vessels 28:596–605PubMedCrossRef
20.
Zurück zum Zitat Furlan R, Jacob G, Snell M, Robertson D, Porta A, Harris P, Mosqueda-Garcia R (1998) Chronic orthostatic intolerance: a disorder with discordant cardiac and vascular sympathetic control. Circulation 98:2154–2159PubMedCrossRef Furlan R, Jacob G, Snell M, Robertson D, Porta A, Harris P, Mosqueda-Garcia R (1998) Chronic orthostatic intolerance: a disorder with discordant cardiac and vascular sympathetic control. Circulation 98:2154–2159PubMedCrossRef
21.
Zurück zum Zitat Stewart J (2002) Pooling in chronic orthostatic intolerance. Arterial vasoconstrictive but not venous compliance defects. Circulation 105:2274–2281PubMedCrossRef Stewart J (2002) Pooling in chronic orthostatic intolerance. Arterial vasoconstrictive but not venous compliance defects. Circulation 105:2274–2281PubMedCrossRef
23.
Zurück zum Zitat Robertson D (1999) The epidemic of orthostatic tachycardia and orthostatic intolerance. Am J Med Sci 317:75–77PubMedCrossRef Robertson D (1999) The epidemic of orthostatic tachycardia and orthostatic intolerance. Am J Med Sci 317:75–77PubMedCrossRef
24.
Zurück zum Zitat Rowe PC, Bou-Holaigah I, Kan JS, Calkins H (1995) Is neurally mediated hypotension an unrecognised cause of chronic fatigue? Lancet 345:623–624PubMedCrossRef Rowe PC, Bou-Holaigah I, Kan JS, Calkins H (1995) Is neurally mediated hypotension an unrecognised cause of chronic fatigue? Lancet 345:623–624PubMedCrossRef
25.
Zurück zum Zitat Jacobs G, Costa F, Shannon JR, Robertson RM, Wathen M, Stein M, Biaggioni I, Ertl A, Black B, Robertson D (2000) The neuropathic postural tachycardia syndrome. N Engl J Med 343:1008–1014CrossRef Jacobs G, Costa F, Shannon JR, Robertson RM, Wathen M, Stein M, Biaggioni I, Ertl A, Black B, Robertson D (2000) The neuropathic postural tachycardia syndrome. N Engl J Med 343:1008–1014CrossRef
26.
Zurück zum Zitat Yoshiuchi K, Farkas J, Natelson B (2006) Patients with chronic fatigue syndrome have reduced absolute cortical blood flow. Clin Physiol Funct Imaging 26:83–86PubMedCrossRef Yoshiuchi K, Farkas J, Natelson B (2006) Patients with chronic fatigue syndrome have reduced absolute cortical blood flow. Clin Physiol Funct Imaging 26:83–86PubMedCrossRef
27.
Zurück zum Zitat Tanaka H, Matsushima R, Tamai H, Kajimoto Y (2002) Impaired postural cerebral hemodynamics in young patients with chronic fatigue with and without orthostatic intolerance. J Pediatr 140:412–417PubMedCrossRef Tanaka H, Matsushima R, Tamai H, Kajimoto Y (2002) Impaired postural cerebral hemodynamics in young patients with chronic fatigue with and without orthostatic intolerance. J Pediatr 140:412–417PubMedCrossRef
28.
Zurück zum Zitat Newton JL, Sheth A, Shin J, Pairman J, Wilton K, Burt JA, Jones DE (2009) Lower ambulatory blood pressure in chronic fatigue syndrome. Psychosom Med 71:361–365PubMedCrossRef Newton JL, Sheth A, Shin J, Pairman J, Wilton K, Burt JA, Jones DE (2009) Lower ambulatory blood pressure in chronic fatigue syndrome. Psychosom Med 71:361–365PubMedCrossRef
29.
Zurück zum Zitat Raj SR, Biaggioni I, Yamhure PC, Black BK, Paranjape SY, Byrne DW, Robertson D (2005) Renin-aldosterone paradox and perturbed blood volume regulation underlying postural tachycardia syndrome. Circulation 111:1574–1578PubMedCrossRef Raj SR, Biaggioni I, Yamhure PC, Black BK, Paranjape SY, Byrne DW, Robertson D (2005) Renin-aldosterone paradox and perturbed blood volume regulation underlying postural tachycardia syndrome. Circulation 111:1574–1578PubMedCrossRef
30.
Zurück zum Zitat Miwa K, Fujita M (2014) Renin–aldosterone paradox in patients with myalgic encephalomyelitis and orthostatic intolerance. Int J Cardiol 172:514–515PubMedCrossRef Miwa K, Fujita M (2014) Renin–aldosterone paradox in patients with myalgic encephalomyelitis and orthostatic intolerance. Int J Cardiol 172:514–515PubMedCrossRef
31.
Zurück zum Zitat Scott LV, Dinam TG (1998) Urinary free cortisol excretion in chronic fatigue syndrome, major depression and in healthy volunteers. J of Affect Disord 47:49–53CrossRef Scott LV, Dinam TG (1998) Urinary free cortisol excretion in chronic fatigue syndrome, major depression and in healthy volunteers. J of Affect Disord 47:49–53CrossRef
32.
Zurück zum Zitat Demitrack MA, Crofford LJ (1998) Evidence for and pathologic implication of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome. Ann NY Acad Sci 840:684–697PubMedCrossRef Demitrack MA, Crofford LJ (1998) Evidence for and pathologic implication of hypothalamic-pituitary-adrenal axis dysregulation in fibromyalgia and chronic fatigue syndrome. Ann NY Acad Sci 840:684–697PubMedCrossRef
33.
Zurück zum Zitat Pagani M, Lucini D (1999) Chronic fatigue syndrome: a hypothesis focusing on the autonomic nervous system. Clin Sci 96:117–125PubMedCrossRef Pagani M, Lucini D (1999) Chronic fatigue syndrome: a hypothesis focusing on the autonomic nervous system. Clin Sci 96:117–125PubMedCrossRef
34.
Zurück zum Zitat Curtis AM, Cheng Y, Kapoor S, Reilly D, Price TS, FitzGerald GA (2007) Circadian variation of blood pressure and the vascular response to asynchronous stress. Proc Natl Acad Sci USA 104:3450–3455PubMedCentralPubMedCrossRef Curtis AM, Cheng Y, Kapoor S, Reilly D, Price TS, FitzGerald GA (2007) Circadian variation of blood pressure and the vascular response to asynchronous stress. Proc Natl Acad Sci USA 104:3450–3455PubMedCentralPubMedCrossRef
Metadaten
Titel
Cardiac dysfunction and orthostatic intolerance in patients with myalgic encephalomyelitis and a small left ventricle
verfasst von
Kunihisa Miwa
Publikationsdatum
01.07.2015
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 4/2015
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-014-0510-y

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