Discussion in 'General ME/CFS News' started by Sushi, Jan 2, 2018.
I haven't seen this posted though it is a few months old:
BNP appears to be increased in mitral valve prolapse and afib, both conditions that seem to often appear with MECFS. I wonder if they excluded those conditions too?
I'm also confused because it seems like the patients with the higher Fatigue Impact Score (95) had the lower BNP scores (<400)? It seems like the higher BNP scores should go along with the higher FIS to me.
BNP has been used in the past to indirectly measure volume status. It can be useful in patients history of CHF. The concept of measuring volume status in ME/CFS patients is interesting especially considering that genetic profiles for this illness supposedly resemble sepsis or SIRS.
However, BNP can be unreliable in patients with decreased kidney function. Perhaps a researcher can investigate using other ways to indirectly measure pulmonary wedge pressure.
It raises some other interesting questions. Do ME/CFS patients who are moderate to severe develop diastolic dysfunction over time due to inactivity?
Its long been recognised that diastolic heart failure is a leading cause of death in ME. This is not seen in other highly sedentary populations. This does not rule out inactivity as a contributing factor, it means that its most likely not a primary cause.
I am of course presuming a relationship between diastolic dysfunction and diastolic heart failure. Please feel free to elaborate.
"Potassium depletion produces diastolic dysfunction in animal and human models (15)."
I was not aware the diastolic heart failure is a leading cause of death in ME. Are there papers or case reports that describe this phenomenon?
Diastolic dysfunction notes less compliance of cardiac muscle which leads to poor filling. It is often difficult to treat but similar medications for CHF are used - beta blockers, ACE or ARB, and diuretics. It would be interesting to compare 2D Echo of different subsets of ME/CFS patients (ie severe bedridden for years, moderate to severe, moderate, mild-moderate, mild). I can imagine a researcher using data from activity monitor to help categorize patients. Other confounding factors would need to be considered such as concominant hypertension, diabetes, and age.
My interpretation is that higher FIS scores would correlate with BNP scores if heart failure symptoms were the cause of fatigue.
I wish the study better characterized ME/CFS patients. ie how many years did they suffer from ME/CFS, severity of illness, post viral vs gradual onset, activity level before and after onset of illness
Potassium depletion is also found in ME in about half of all patients. This is research from the 90s in South Australia. They used some kind of scan that measured total body potassium. Serum levels often appear normal.
Its been discussed many times, including on this forum. Many of the ME docs we talk about have mentioned it. It was listed in one of Jason's papers on cause of death, going back some years now. Paul Cheney and a few others have suggested that diastolic heart failure is a key mechanism of ME. I do not have any links handy. Its also been discussed that we often appear to have normal heart function lying down, but if you do a standing test our hearts fail to pump adequate blood. This research goes back to about 2000 or prior. Its not new.
Having recently been diagnosed with LVDD (HFpEF -- Heart Failure with Preserved Ejection Fraction) and Pulmonary Hypertension, this subject is of particular interest to me.
The Jason paper (see attached) certainly caught my attention but its findings certainly have their detractors:
I'm not at all sure what to make of it. HFpEF does carry pretty miserable mortality statistics -- average life expectancy of something around two years. Five year mortality rates around 75%. It wouldn't surprise me if PWME and HFpEF died significantly earlier than the general population.
I also wouldn't be surprised if there was a particular subset of PWME whose true etiology was more closely related to ventricular dysfunction -- even if that ventricular dysfunction was, itself, caused by some sort of immune dysregulation (eg, an infiltrative cardiomyopathy) than to anything else.
A couple more relevant articles:
Cardiac Involvement in Patients With CFS
PREVALENCE OF ABNORMAL CARDIAC WALL MOTION IN THE CARDIOMYOPATHY ASSOCIATED WITH INCOMPLETE MULTIPLICATION OF EPSTEIN-
BARR VIRUS AND/OR CYTOMEGALOVIRUS IN PATIENTS WITH CHRONIC FATIGUE SYNDROME
And that's aside from the excellent series on this site:
It looks like this is an area that deserves further study. Hopefully it will be easier now and in the future as researchers share data.
Both hypokalemic Periodic paralysis patients (channelopathy) and Myathenia Gravis patients (auto-antibodies/neuromuscular junction impairment) are sensitive to blood potassium variations, and I do believe ME/CFS patients as well. This would mean worsening of their symptoms (either cardiac or muscular) when blood potassium falls below a certain range (even within the normal ranges);
@Freddd found that he was better when his blood potassium is not below 4.2, and it seems that I am in that case too.
(normal ranges are 3.6 to 5.2 mmol/l).
I found that KCl in the liquid form was best to help me. It is used also by HypoKPP patient to manage their symptoms.
As it compets with B12 absorption, you need B12 injections while taking KCl.
I found this link to be very informative to help people managing KCl supplementation:
Potassium: Effect on Blood Levels
Potassium Dose Increase in Serum Potassium Concentration
40 – 60 mEq 1.0 – 1.5 mEq /L (mmol/l)
Each 20 mEq KCl orally lead to increase of 0.5 mEq K in blood
MEA Summary Review: Elevated BNP levels in ME/CFS associate with
cardiac dysfunction | 14 February 2018
By Charlotte Stephens, 14th February 2018.
A recent study from a research group at Newcastle University has found that patients with ME/CFS have significantly higher levels of a hormone called BNP in their blood and that this also correlated with significantly lower cardiac volumes.
Structural and functional cardiac abnormalities have been reported in ME/CFS before and MRI studies have suggested subclinical cardiomyopathy in some.
Finding a cause for the cardiac abnormalities and raised BNP levels seen in patients could help in the discovery of the physiological mechanisms behind the disease and could also help to direct treatment routes.
Overview of the study
The study aimed to look at BNP levels and how these associate with the cardiac abnormalities recently identified in ME/CFS.
Cardiac magnetic resonance (MR) examinations and BNP measurements were performed on 42 patients with ME/CFS (meeting the Fukuda criteria) and 10 sedentary controls, all with an average age of 46.
BNP levels were found to be significantly higher in the ME/CFS cohort compared with controls. The authors also found that those with higher BNP levels had significantly lower cardiac volumes.
There were no relationships between fatigue severity, length of disease and BNP levels, suggesting that the findings are unlikely to be related to deconditioning.
‘This study confirms an association between reduced cardiac volumes and BNP in CFS. Lack of relationship between length of disease suggests that findings are not secondary to deconditioning. Further studies are needed to explore the utility of BNP to act as a stratification paradigm in CFS that directs targeted treatments.’
Read the full review online or as a download
Excellent timing, @Dolphin!
I have been trying to get this tested for the last three months and I can't find an applicable diagnosis code so Medicare will pay for it.
I'm going to keep looking. Surely there is something that will apply to me.
I found the original article that was referenced in one of the links above. I'm slowly working my way through it.
[see attached PDF]
It seems to support a theory that's been around for quite a while and that I subscribe to: that a subset of ME/CFS patients are really some form of Heart Failure patients.
An endomyocardial biopsy (EMB) is NOT a trivial procedure. It's interesting, though, that the EMBs done on the CFS patients in this study found heart problems at the cellular level, most commonly associated with cardiomyopathy.
If the pump doesn't work right ... all kinds of medical issues can result.
I've been pursuing an endomyocardial biopsy to try to determine what's at the core of my Heart Failure and Pulmonary Hypertension. I have corresponded with some of the best Heart Failure specialists in the USA. None has expressed a willingness to order an EMB for me.
In corresponding with a cardiologist from the Mayo Clinic, his recommendation was that I be seen in Berlin, Germany by a research cardiologist who seems to specialize in cases like mine. Unfortunately, apart from traveling half-way around the world, it's a cash-pay situation with costs in excess of US$35,000. It involves a four-day inpatient stay and loads of tests in addition to the EMB.
And no guarantee of either a firm diagnosis (many of the things that an EMB can diagnose don't affect the entire heart. They are what's called 'patchy.' That means that when they take a handful of samples it's possible that they'll miss the problem areas) or that what they find is even treatable.
I'm doing everything I can to find a similar option in the US where they accept my insurance.
I think this totally explains the salt wasting and hypovolemia seen in dysautonomia.
The elevated BNP inhibits aldosterone release, which is why supplemental Florinef often helps.
BNP also inhibits autonomic outflow at the level of the brainstem.
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