E2 ModeratePreliminaryPEM not requiredCross-SectionalPeer-reviewedReviewed
Repetitively negative changing T waves at 24-h electrocardiographic monitors in patients with the chronic fatigue syndrome. Left ventricular dysfunction in a cohort.
Lerner, A M, Lawrie, C, Dworkin, H S · Chest · 1993 · DOI
Quick Summary
This study looked at heart activity recorded over 24 hours in ME/CFS patients compared to others. All 24 ME/CFS patients showed unusual patterns on their heart monitors (abnormal T waves), compared to only 22% of people without ME/CFS. Further testing found that 8 out of 60 ME/CFS patients had mild heart pumping problems that only showed up during exercise, even though their resting heart function appeared normal. The researchers suggest ME/CFS fatigue might be related to the heart not working well during normal daily activities.
Why It Matters
This early study provides objective evidence of cardiac abnormalities in ME/CFS that are not explained by traditional coronary disease, suggesting the fatigue may have a physiological basis in cardiac function. The finding that heart dysfunction emerges during normal activity levels—not just extreme exertion—is particularly relevant for understanding why ME/CFS patients experience fatigue with everyday tasks.
Observed Findings
- 100% (24/24) of CFS patients showed abnormal repetitive T wave changes on 24-hour Holter monitoring, compared to 22.4% of non-CFS patients (p < 0.01).
- Mild left ventricular dysfunction occurred in 8 of 60 CFS patients during stress testing (MUGAs).
- Resting ejection fractions were normal (~60%) in the CFS cohort, but dysfunction emerged with increasing workloads.
- Abnormal cardiac findings occurred in young CFS patients (≤50 years) with no risk factors for coronary artery disease.
Inferred Conclusions
- ME/CFS patients have significantly higher rates of abnormal cardiac electrical patterns than control populations.
- Cardiac dysfunction in ME/CFS is exercise-inducible and may not be detectable at rest.
- The fatigue experienced by ME/CFS patients may be mechanistically related to impaired cardiac performance during ordinary physical demands.
Remaining Questions
- What causes these cardiac abnormalities in ME/CFS—are they primary, viral-triggered, or secondary adaptations?
- Do the T wave abnormalities seen on Holter monitoring directly correlate with the structural/functional dysfunction seen on stress testing?
- How do these cardiac findings relate to post-exertional malaise and exercise intolerance in ME/CFS?
What This Study Does Not Prove
This study does not prove that cardiac dysfunction causes ME/CFS fatigue, only that it co-occurs in some patients. The observational design and small sample size (24 initial CFS cases, 8 with dysfunction) mean findings may not generalize to all ME/CFS populations. The study cannot determine whether the cardiac abnormalities are primary to the disease or secondary consequences.
Tags
Symptom:Post-Exertional MalaiseFatigue
Biomarker:Blood Biomarker
Method Flag:Weak Case DefinitionSmall SampleExploratory Only
Metadata
- DOI
- 10.1378/chest.104.5.1417
- PMID
- 8222798
- Review status
- Editor reviewed
- Evidence level
- Single-study or moderate support from human research
- Last updated
- 12 April 2026
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 →
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