Evaluation of a chronic fatigue in patients with moderate-to-severe chronic heart failure]

The aim of the study. 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. Material and methods. A total of 1.70 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). Conclusion. 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.