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 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.