[Evaluation of a chronic fatigue in patients with moderate-to-severe chronic heart failure].
OBJECTIVE
To evaluate the chronic fatigue and its relation to the function of hypothalamus-pituitary-adrenal axis in patients with New York Heart Association (NYHA) functional class III-IV chronic heart failure.


METHODS
A total of 170 patients with NYHA functional class III-IV chronic heart failure completed MFI-20L, DUFS, and DEFS questionnaires assessing chronic fatigue and underwent echocardiography. Blood cortisol concentration was assessed at 8:00 am and 3:00 pm, and plasma N-terminal brain natriuretic pro-peptide (NT-proBNP) concentration was measured at 8:00 am. Neurohumoral investigations were repeated before cardiopulmonary exercise test and after it.


RESULTS
The results of all questionnaires showed that 100% of patients with NYHA functional class III-IV heart failure complained of chronic fatigue. The level of overall fatigue was 54.5+/-31.5 points; physical fatigue - 56.8+/-24.6 points. Blood cortisol concentration at 8:00 am was normal (410.1+/-175.1 mmol/L) in majority of patients. Decreased concentration was only in four patients (122.4+/-15.5 mmol/L); one of these patients underwent heart transplantation. In the afternoon, blood cortisol concentration was insufficiently decreased (355.6+/-160.3 mmol/L); reaction to a physical stress was attenuated (Delta 92.9 mmol/L). Plasma NT-proBNP concentration was 2188.9+/-1852.2 pg/L; reaction to a physical stress was diminished (Delta 490.3 pg/L).


CONCLUSIONS
All patients with NYHA class III-IV heart failure complained of daily chronic fatigue. Insufficiently decreased blood cortisol concentration in the afternoon showed that in the presence of chronic fatigue in long-term cardiovascular organic disease, disorder of a hypothalamus-pituitary-adrenal axis is involved.
Institute of Cardiology, Kaunas University of Medicine, Lithuania. lina.jas@med.kmu.lt
Lina
L
Jasiukeviciene
Donatas
D
Vasiliauskas
Ausra
A
Kavoliūniene
Jolanta
J
Marcinkeviciene
Regina
R
Grybauskiene
Vytautas
V
Grizas
Vida
V
Tumyniene
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography; D015673:Fatigue Syndrome, Chronic / Q000097:blood / Q000175:diagnosis* / Q000209:etiology*; D006333:Heart Failure / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology*; D016027:Heart Transplantation; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007030:Hypothalamo-Hypophyseal System / Q000503:physiopathology; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010101:Oxygen Consumption; D010446:Peptide Fragments / Q000097:blood; D005082:Physical Exertion; D010913:Pituitary-Adrenal System / Q000503:physiopathology; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D013997:Time Factors; D016277:Ventricular Function, Left
D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D006854:Hydrocortisone