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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
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Evaluation of a chronic fatigue in patients with moderate-to-severe chronic heart failure

1
Institute of Cardiology
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Department of Cardiology, Kaunas University of Medicine, Lithuania
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Author to whom correspondence should be addressed.
Medicina 2008, 44(5), 366; https://doi.org/10.3390/medicina44050047
Received: 20 March 2007 / Accepted: 12 March 2008 / Published: 17 March 2008
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 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 (∆ 92.9 mmol/L). Plasma NTproBNP concentration was 2188.9±1852.2 pg/L; reaction to a physical stress was diminished (∆ 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.
Keywords: chronic heart failure; chronic fatigue; left ventricular ejection fraction; oxygen consumption chronic heart failure; chronic fatigue; left ventricular ejection fraction; oxygen consumption
MDPI and ACS Style

Jasiukevičienė, L.; Vasiliauskas, D.; Kavoliūnienė, A.; Marcinkevičienė, J.; Grybauskienė, R.; Grižas, V.; Tumynienė, V. Evaluation of a chronic fatigue in patients with moderate-to-severe chronic heart failure. Medicina 2008, 44, 366.

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