Ayres, J G, Wildman, M, Groves, J et al. · QJM : monthly journal of the Association of Physicians · 2002 · DOI
This study followed people who had Q fever (a bacterial infection) during an outbreak in 1989 to see if persistent fatigue afterward was caused by heart damage. Researchers tested their hearts using ECGs, ultrasounds, and exercise tests over many years. They found that people with ongoing fatigue after Q fever did not have hidden heart problems, though a few people did develop serious heart infections from the original infection.
This study is important because it addresses a longstanding concern about whether post-infectious fatigue syndromes like ME/CFS might be caused by hidden heart disease. The structured cardiac evaluation and comparison with controls provides evidence that fatigue after Q fever is not explained by subclinical cardiomyopathy, helping distinguish post-infectious fatigue from primary cardiac conditions.
This study does not prove that ME/CFS has no cardiac involvement—it only addresses subclinical cardiomyopathy specifically and uses historical Q fever data rather than primary ME/CFS populations. The study cannot rule out other cardiac abnormalities beyond structural changes detectable by ECG and echocardiography, such as autonomic dysfunction or microvasculature disease. Additionally, findings from one infection may not generalize to ME/CFS from other viral triggers.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Ayres, J G, Wildman, M, Groves, J, Ment, J, Smith, E G, & Beattie, J M (2002). Long-term follow-up of patients from the 1989 Q fever outbreak: no evidence of excess cardiac disease in those with fatigue.. QJM : monthly journal of the Association of Physicians. https://doi.org/10.1093/qjmed/95.8.539
BibTeX
@article{mecfsatlas-ayres-2002-long-term,
author = {Ayres, J G and Wildman, M and Groves, J and Ment, J and Smith, E G and Beattie, J M},
title = {Long-term follow-up of patients from the 1989 Q fever outbreak: no evidence of excess cardiac disease in those with fatigue.},
journal = {QJM : monthly journal of the Association of Physicians},
year = {2002},
doi = {10.1093/qjmed/95.8.539},
note = {PubMed: 12145393},
url = {https://www.mecfsatlas.com/evidence/ayres-2002-long-term},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-27. https://www.mecfsatlas.com/evidence/ayres-2002-long-term
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