Derangement of hypothalamus-pituitary-adrenal axis in patients with severe chronic heart failure

Abstract

Introduction: Chronic fatigue and chronic fatigue syndrome are characterized as disorder of hypothalamus-pituitary-adrenal axis which in definitive stages is definable as exhaustion of adrenal function and atrophy of adrenal glands. Long-term internal sympathetic activity in patients with chronic heart failure and its impact on cardiorespiratory function is underestimated. We assessed the hypothesis that chronic fatigue severity is related not only to left ventricular dysfunction, and that long-term internal sympathetic activity in patients with moderate-to-severe chronic heart failure impacts on a hypothalamus-pituitary-adrenal axis. Methods: One hundred and ten patients with III-IV class (NYHA) chronic heart failure filled in chronic fatigue questionnaires MFI-20L (100 point scale), DUFS and DEFS (9 point scales each) and underwent Doppler echocardiography and cardiopulmonary exercise testing, underwent a.m. and p.m. blood cortisol and plasma NT-proBNP analysis. Regression analysis relating neurohumoral and cardiorespiratory findings to MFI-20L scale of overall and physical fatigue results was performed, and Spearman’s rank correlation coefficients were calculated. Results: Fifty patients with III class (NYHA) scored 45.8±25.5 points, and sixty patients with IV class (NYHA) - 58.8±28.8 points of overall chronic fatigue according to MFI-20L questionnaire scale. In patients with III (NYHA) class a.m. blood cortisol concentration was normal (552.1±95.111 mmol/l), and p.m. blood cortisol concentration was diminished within normal range –(289.5±149.222 mmol/l). In patients with IV (NYHA) class a.m. blood cortisol concentration was normal (410.1±175.111 mmol/l), and p.m. blood cortisol concentration was insufficiently diminished –(355.6±160.333 mmol/l). Chronic fatigue had a significant and moderate relation to age and ventilating equivalent VE/VCO2, significant and moderate inverse relation to blood cortisol concentration, and weak relation to left.