Cardiac Involvement in CFS Studied

Research on chronic fatigue syndrome (CFS) presented by Dr. Martin Lerner at the American Society of Microbiology meeting in Toronto in September has received considerable media attention. Lerner, an infectious disease specialist and clinical professor at Wayne State University School of Medicine in Detroit, believes that the cause of CFS is a continuing or reactivated cardiac infection by Epstein-Barr virus (EBV) and cytomegalovirus (CMV).

Lerner has been exploring possible associations between CFS and viral myocarditis since 1988 when he became ill with CFS. He hypothesizes that damage to the heart muscle can cause CFS symptoms in a subset of patients, and that it can be treated with antiviral drugs.

Data from two new studies Lerner presented at the September meeting showed that 95% of CFS patients tested by holter monitoring had abnormal electrocardiograms (ECGs), including oscillating or flat/inverted T waves. Approximately 25% of healthy subjects had abnormal ECGs. Right ventricular endomyocardial biopsies performed on the CFS patients showed microfiber disarray, hypertrophy and mild fibrosis.

According to Lerner, 10 of the CFS patients who tested positive for EBV but not CMV and had been ill for less than 2 years improved when given intravenous and oral valacyclovir for 6 months. Nine patients with co-infections (EBV-CMV) who received valacyclovir did not improve. None of the patients treated received a placebo. Glaxo-Wellcome is currently conducting a trial of valacyclovir vs. placebo for the therapy of CFS in patients with evidence of T-wave abnormalities.

Clinicians should keep in mind that the studies presented by Lerner were performed on a small number of patients. In addition, the cardiac abnormalities are described as mild and showed up in a high percentage of the controls.