Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography
Objective: The underlying hypothesis in orthostatic intolerance (OI) syndromes is that symptoms are associated with cerebral blood flow (CBF) reduction. Indirect CBF measurements (transcranial Doppler flow velocities), provide inconsistent support of this hypothesis. The aim of the study was to meas...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-01-01
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| Series: | Clinical Neurophysiology Practice |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2467981X20300044 |
| _version_ | 1819072518560940032 |
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| author | C. (Linda) M.C. van Campen Freek W.A. Verheugt Peter C. Rowe Frans C. Visser |
| author_facet | C. (Linda) M.C. van Campen Freek W.A. Verheugt Peter C. Rowe Frans C. Visser |
| author_sort | C. (Linda) M.C. van Campen |
| collection | DOAJ |
| description | Objective: The underlying hypothesis in orthostatic intolerance (OI) syndromes is that symptoms are associated with cerebral blood flow (CBF) reduction. Indirect CBF measurements (transcranial Doppler flow velocities), provide inconsistent support of this hypothesis. The aim of the study was to measure CBF during a 30 min head-up tilt test (HUT), using Doppler flow imaging of carotid and vertebral arteries, in individuals with chronic fatigue syndrome/myalgic encephalomyelitis (ME/CFS), a condition with a high prevalence of OI. Methods: 429 ME/CFS patients were studied: 247 had a normal heart rate (HR) and blood pressure (BP) response to HUT, 62 had delayed orthostatic hypotension (dOH), and 120 had postural orthostatic tachycardia syndrome (POTS). We also studied 44 healthy controls (HC). CBF measurements were made at mid-tilt and end-tilt. Before mid-tilt, we administered a verbal questionnaire to ascertain for 15 OI symptoms. Results: End-tilt CBF reduction was 7% in HC versus 26% in the overall ME/CFS group, 24% in patients with a normal HR/BP response, 28% in those with dOH, and 29% in POTS patients (all P < .0005). Using a lower limit of normal of 2SD of CBF reduction in HC (13% reduction), 82% of patients with normal HR/BP response, 98% with dOH and 100% with POTS showed an abnormal CBF reduction. There was a linear correlation of summed OI symptoms with the degree of CBF reduction at mid-tilt (P < .0005). Conclusions: During HUT, extracranial Doppler measurements demonstrate that CBF is reduced in ME/CFS patients with POTS, dOH, and even in those without HR/BP abnormalities. Significance: This study shows that orthostatic intolerance symptoms are related to CBF reduction, and that the majority of ME/CFS patients (90%) show an abnormal cerebral flow reduction during orthostatic stress testing. This may have implications for the diagnosis and treatment of ME/CFS patients. |
| first_indexed | 2024-12-21T17:39:00Z |
| format | Article |
| id | doaj.art-1376928bd16e46a8930f47d8559bbdd7 |
| institution | Directory Open Access Journal |
| issn | 2467-981X |
| language | English |
| last_indexed | 2024-12-21T17:39:00Z |
| publishDate | 2020-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical Neurophysiology Practice |
| spelling | doaj.art-1376928bd16e46a8930f47d8559bbdd72022-12-21T18:55:41ZengElsevierClinical Neurophysiology Practice2467-981X2020-01-0155058Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echographyC. (Linda) M.C. van Campen0Freek W.A. Verheugt1Peter C. Rowe2Frans C. Visser3Stichting CardioZorg, Planetenweg 5, 2132 HN Hoofddorp, The Netherlands; Corresponding author at: Planetenweg 5, 2132 HN Hoofddorp, The Netherlands.Department of Cardiology, Onze Lieve Vrouwe Gasthuis (OLVG), Oosterpark 9, 1091 AC Amsterdam, The NetherlandsDepartment of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USAStichting CardioZorg, Planetenweg 5, 2132 HN Hoofddorp, The NetherlandsObjective: The underlying hypothesis in orthostatic intolerance (OI) syndromes is that symptoms are associated with cerebral blood flow (CBF) reduction. Indirect CBF measurements (transcranial Doppler flow velocities), provide inconsistent support of this hypothesis. The aim of the study was to measure CBF during a 30 min head-up tilt test (HUT), using Doppler flow imaging of carotid and vertebral arteries, in individuals with chronic fatigue syndrome/myalgic encephalomyelitis (ME/CFS), a condition with a high prevalence of OI. Methods: 429 ME/CFS patients were studied: 247 had a normal heart rate (HR) and blood pressure (BP) response to HUT, 62 had delayed orthostatic hypotension (dOH), and 120 had postural orthostatic tachycardia syndrome (POTS). We also studied 44 healthy controls (HC). CBF measurements were made at mid-tilt and end-tilt. Before mid-tilt, we administered a verbal questionnaire to ascertain for 15 OI symptoms. Results: End-tilt CBF reduction was 7% in HC versus 26% in the overall ME/CFS group, 24% in patients with a normal HR/BP response, 28% in those with dOH, and 29% in POTS patients (all P < .0005). Using a lower limit of normal of 2SD of CBF reduction in HC (13% reduction), 82% of patients with normal HR/BP response, 98% with dOH and 100% with POTS showed an abnormal CBF reduction. There was a linear correlation of summed OI symptoms with the degree of CBF reduction at mid-tilt (P < .0005). Conclusions: During HUT, extracranial Doppler measurements demonstrate that CBF is reduced in ME/CFS patients with POTS, dOH, and even in those without HR/BP abnormalities. Significance: This study shows that orthostatic intolerance symptoms are related to CBF reduction, and that the majority of ME/CFS patients (90%) show an abnormal cerebral flow reduction during orthostatic stress testing. This may have implications for the diagnosis and treatment of ME/CFS patients.http://www.sciencedirect.com/science/article/pii/S2467981X20300044Orthostatic intoleranceCerebral blood flowTilt table testingME/CFSPostural orthostatic tachycardia syndromeOrthostatic hypotension |
| spellingShingle | C. (Linda) M.C. van Campen Freek W.A. Verheugt Peter C. Rowe Frans C. Visser Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography Clinical Neurophysiology Practice Orthostatic intolerance Cerebral blood flow Tilt table testing ME/CFS Postural orthostatic tachycardia syndrome Orthostatic hypotension |
| title | Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography |
| title_full | Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography |
| title_fullStr | Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography |
| title_full_unstemmed | Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography |
| title_short | Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography |
| title_sort | cerebral blood flow is reduced in me cfs during head up tilt testing even in the absence of hypotension or tachycardia a quantitative controlled study using doppler echography |
| topic | Orthostatic intolerance Cerebral blood flow Tilt table testing ME/CFS Postural orthostatic tachycardia syndrome Orthostatic hypotension |
| url | http://www.sciencedirect.com/science/article/pii/S2467981X20300044 |
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