Neurohumoral and Hemodynamic Profile in Postural Tachycardia and Chronic Fatigue Syndromes
– Source: Clinical Science, Sep 12, 2011
By Luis E Okamoto, Italo Biaggioni, et al.
Several studies recognized an overlap between chronic fatigue (CFS) and postural tachycardia (POTS) syndromes.
We compared the autonomic and neurohormonal phenotype of POTS patients with CFS (CFS-POTS) to those without CFS (non-CFS POTS), to determine whether CFS-POTS represents a unique clinical entity with a distinct pathophysiology.
We recruited 58 patients with POTS, of which 47 were eligible to participate: 93% of them reported severe fatigue (Checklist Individual Strength [CIS], fatigue subscale <36), and 64% (n=30) fulfilled criteria for CFS (CFS-POTS).
• The prevalence of CFS symptoms (Centers for Disease Control and Prevention criteria) was greater in the CFS-POTS group
• But the pattern of symptoms was similar in both groups.
• Physical functioning was low in both groups (RAND-36 Health Survey, 40±4 vs. 33±3, p=0.153),
• Despite more severe fatigue in CFS-POTS patients (CIS fatigue subscale 51±1 vs. 43±3, p=0.016).
• CFS-POTS patients had:
– Greater orthostatic tachycardia than the non-CFS POTS group (51 +/- 3 vs. 40 +/- 4 bpm, p=0.030),
– Greater low frequency variability of blood pressure (6.3+/-0.7 vs. 4.8+/-1.0 mmHg2, p=0.019),
– Greater BP recovery from early to late phase II of the Valsalva maneuver (18+/-3 vs. 11+/-2 mmHg, p=0.041),
– And a higher supine (1.5+/-0.2 vs. 1.0+/-0.3 ng/mL/h; p=0.033) and upright (5.4+/-0.6 vs. 3.5+/-0.8 ng/mL/h; p=0.032) plasma renin activity.
• Fatigue and CFS-defining symptoms are common in POTS patients. The majority of them met criteria for CFS.
• CFS-POTS patients have higher markers of sympathetic activation but are part of the spectrum of POTS.
• Targeting this sympathetic activation should be considered in the treatment of these patients.
Source: Clinical Science, Sep 12, 2011. DOI:doi:10.1042/CS20110200 by Okamoto LE, Raj SR, Peltier AC, Gamboa A, shibao CA, Dierich A, Black BK, Robertson D, Biaggioni I. Vanderbilt University School of Medicine, Nashville, Tennessee, USA. [Email: Italo.Biaggioni@Vanderbilt.edu]