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Abstract
Background
Aberrations of cardiovascular regulation have been reported in patients who suffer with fibromyalgia (FM). Abnormalities of the cardiovascular autonomic regulation, as well as the correlation between coronary heart disease and depression, have been considered to be the causative factors. The clinical features of transient left apical ballooning syndrome with the patients under acute stress have been clearly described, but the effect of chronic stress such as FM on the myocardium is unknown. We investigated the cardiac strain in FM patients by strain imaging with using the 2D grayscale images, and we quantified the regional myocardial deformation properties.
Methods
We investigated 30 consecutive postmenopausal women (mean age: 48±8 years) who satisfied the criteria for fibromyalgia with atypical chest pain by performing standard and 2-dimensional strain echocardiography (2DS). Those patients with hypertension, coronary heart disease or diabetes were excluded. The global and segmental longitudinal deformation parameters of the LV from 3 apical views were analyzed, and the patients underwent a manual tender point survey for determining the number of tender points and tender point counts, and the patients completed the fibromyalgia impact questionnaire (FIQ), the brief fatigue inventory (BFI), and Beck depression inventory (BDI).
Results
The global longitudinal LV strain was significantly reduced in the FM patients with a high FIQ score (＞40) as compared to the patients with a low FIQ score (−18.61% vs. −22.72%). Also, both the global and segmental longitudinal LV strains were negatively associated with fatigue or the tender point counts. However, there was no significant association between depression and the LV strain.
References
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Fig. 1.
Longitudinal strain was obtained from the 3 apical chamber views by 2-dimensional speckle tracking strain analysis.
Table 1.
Baseline demographic characteristics of the FMS patients and the controls
Table 2.
Comparisons of the clinical variables between the FMS patients
| Group A (n=20) | Group B (n=10) | p | |
|---|---|---|---|
| FIQ | 70.01 | 34.15 | 0.0026 |
| (10.11) | (5.645) | ||
| Physical impairment subscale | 11.5 | 5 | 0.1147 |
| (12.75) | (3.5) | ||
| Feel good subscale | 9.295 | 4.29 | 0.0203 |
| (2.86)∗ | (1.43) | ||
| Work missed subscale | 52 | 26 | 0.0026 |
| (15.5)∗ | (3.5) | ||
| Number of tender point | 14 | 14 | 0.8897 |
| (2) | (3.5) | ||
| Tender point counts | 32.5 | 25 | 0.0366 |
| (7.75)∗ | (5.5) | ||
| Fatigue subscale (BFI) | 59.5 | 30 | 0.0095 |
| (17.5)∗ | (17.5) | ||
| Depression subscale (BDI) | 40 | 30 | 0.0254 |
| (13.75)∗ | (6.25) |
Table 3.
Parameters of the 2-dimensional echocardiography between the FMS patients and the controls
All the values are described as medians (interquartile range), Group A: (FIQ≥40), Group B: (FIQ＜40), FMS: fibromyalgia syndrome, LVEDd: left ventricular end diastolic dimension, FS: fractional shortening, EF: ejection fraction, RWT: relative wall thickness, LVMI: left ventricular mass index, LAD: left atrial dimension, ∗p＜0.05 vs. group B, ∗∗p＜0.05 vs. control
Table 4.
Parameters of the mitral inflow pattern and strain between the FMS patients
| Group A (n=20) | Group B (n=10) | Control (n=20) | |
|---|---|---|---|
| E velocity (cm/sec) | 75 (20) | 72 (19.5) | 74 (14.5) |
| A velocity (cm/sec) | 68.5 (10.75) | 68 (9.75) | 68 (12.5) |
| E/Ea | 8.15 (1.97) | 8.66 (1.365) | 8.05 (2.13) |
| Peak systolic strain, LAX (%) | –18.65 (4.2)∗,∗∗ | –23.5 (2.975) | –22.5 (3.125) |
| Peak systolic strain, A4C (%) | –19 (2.925)∗,∗∗ | –23.2 (1.575) | –23.5 (1.225) |
| Peak early diastoic strain, A2C (%) | –18.75 (3.6)∗,∗∗ | –23 (1.375) | –24 (2.8) |
| Global LV strain (%) | –18.8 (3.45)∗,∗∗ | –23.2 (2.125) | –23.5 (1.875) |
All the values are described as medians (interquartile range), Group A: (FIQ≥40), Group B: (FIQ＜40): FMS: fibromyalgia syndrome, E: peak early velocity, A: peak atrial velocity, Ea: early diastolic mitral annular velocity, LAX: apical long axis view, A4C: apical 4-chamber view, A2C: apical 2-chamber view,
Table 5.
Correlation analysis of the parameters between the patients with FMS; Spearman's correlation coefficient (r)
| Global LV strain of patients with FMS | ||
|---|---|---|
| r | p | |
| FIQ score | 0.59900∗∗ | 0.0016 |
| Physical score | 0.47016∗ | 0.0177 |
| Feel score | 0.57395∗∗ | 0.0027 |
| Work miss | 0.40389∗ | 0.0453 |
| Number of tender point | 0.05635 | 0.7890 |
| Depression (BDI) | 0.28197 | 0.1721 |
| Fatigue (BFI) | 0.46102∗ | 0.0204 |
| E/Ea | 0.32338 | 0.1148 |
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