Orthostatic chronotropic incompetence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
Background: Orthostatic intolerance (OI) is a core diagnostic criterion in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The majority of ME/CFS patients have no evidence of hypotension or postural orthostatic tachycardia syndrome (POTS) during head-up tilt, but do show a significantly...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | IBRO Neuroscience Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667242123000374 |
| _version_ | 1827577216295239680 |
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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 | Background: Orthostatic intolerance (OI) is a core diagnostic criterion in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The majority of ME/CFS patients have no evidence of hypotension or postural orthostatic tachycardia syndrome (POTS) during head-up tilt, but do show a significantly larger reduction in stroke volume index (SVI) when upright compared to controls. Theoretically a reduction in SVI should be accompanied by a compensatory increase in heart rate (HR). When there is an incomplete compensatory increase in HR, this is considered chronotropic incompetence. This study explored the relationship between HR and SVI to determine whether chronotropic incompetence was present during tilt testing in ME/CFS patients. Methods: From a database of individuals who had undergone tilt testing with Doppler measurements for SVI both supine and end-tilt, we selected ME/CFS patients and healthy controls (HC) who had no evidence of POTS or hypotension during the test. To determine the relation between the HR increase and SVI decrease during the tilt test in patients, we calculated the 95% prediction intervals of this relation in HC. Chronotropic incompetence in patients was defined as a HR increase below the lower limit of the 95th % prediction interval of the HR increase in HC. Results: We compared 362 ME/CFS patients with 52 HC. At end-tilt, tilt lasting for 15 (4) min, ME/CFS patients had a significantly lower SVI (22 (4) vs. 27 (4) ml/m2; p < 0.0001) and a higher HR (87 (11) vs. 78 (15) bpm; p < 0.0001) compared to HC. There was a similar relationship between HR and SVI between ME/CFS patients and HC in the supine position. During tilt ME/CFS patients had a lower HR for a given SVI; 37% had an inadequate HR increase. Chronotropic incompetence was more common in more severely affected ME/CFS patients. Conclusion: These novel findings represent the first description of orthostatic chronotropic incompetence during tilt testing in ME/CFS patients. |
| first_indexed | 2024-03-08T21:24:38Z |
| format | Article |
| id | doaj.art-dc9365ce01e9416db8620291b29d9b15 |
| institution | Directory Open Access Journal |
| issn | 2667-2421 |
| language | English |
| last_indexed | 2024-03-08T21:24:38Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | IBRO Neuroscience Reports |
| spelling | doaj.art-dc9365ce01e9416db8620291b29d9b152023-12-21T07:38:20ZengElsevierIBRO Neuroscience Reports2667-24212023-12-0115110Orthostatic chronotropic incompetence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)C. (Linda) M.C. van Campen0Freek W.A. Verheugt1Peter C. Rowe2Frans C. Visser3Stichting CardioZorg, Planetenweg 5, 2132 HN Hoofddorp, The Netherlands; Correspondence to: Planetenweg 5, 2132 HN Hoofddorp, The Netherlands.Radboud UMC, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The NetherlandsDepartment of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USAStichting CardioZorg, Planetenweg 5, 2132 HN Hoofddorp, The NetherlandsBackground: Orthostatic intolerance (OI) is a core diagnostic criterion in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The majority of ME/CFS patients have no evidence of hypotension or postural orthostatic tachycardia syndrome (POTS) during head-up tilt, but do show a significantly larger reduction in stroke volume index (SVI) when upright compared to controls. Theoretically a reduction in SVI should be accompanied by a compensatory increase in heart rate (HR). When there is an incomplete compensatory increase in HR, this is considered chronotropic incompetence. This study explored the relationship between HR and SVI to determine whether chronotropic incompetence was present during tilt testing in ME/CFS patients. Methods: From a database of individuals who had undergone tilt testing with Doppler measurements for SVI both supine and end-tilt, we selected ME/CFS patients and healthy controls (HC) who had no evidence of POTS or hypotension during the test. To determine the relation between the HR increase and SVI decrease during the tilt test in patients, we calculated the 95% prediction intervals of this relation in HC. Chronotropic incompetence in patients was defined as a HR increase below the lower limit of the 95th % prediction interval of the HR increase in HC. Results: We compared 362 ME/CFS patients with 52 HC. At end-tilt, tilt lasting for 15 (4) min, ME/CFS patients had a significantly lower SVI (22 (4) vs. 27 (4) ml/m2; p < 0.0001) and a higher HR (87 (11) vs. 78 (15) bpm; p < 0.0001) compared to HC. There was a similar relationship between HR and SVI between ME/CFS patients and HC in the supine position. During tilt ME/CFS patients had a lower HR for a given SVI; 37% had an inadequate HR increase. Chronotropic incompetence was more common in more severely affected ME/CFS patients. Conclusion: These novel findings represent the first description of orthostatic chronotropic incompetence during tilt testing in ME/CFS patients.http://www.sciencedirect.com/science/article/pii/S2667242123000374Orthostatic intoleranceTilt table testingME/CFSStroke volume indexCardiac indexChronotropic incompetence |
| spellingShingle | C. (Linda) M.C. van Campen Freek W.A. Verheugt Peter C. Rowe Frans C. Visser Orthostatic chronotropic incompetence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) IBRO Neuroscience Reports Orthostatic intolerance Tilt table testing ME/CFS Stroke volume index Cardiac index Chronotropic incompetence |
| title | Orthostatic chronotropic incompetence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) |
| title_full | Orthostatic chronotropic incompetence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) |
| title_fullStr | Orthostatic chronotropic incompetence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) |
| title_full_unstemmed | Orthostatic chronotropic incompetence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) |
| title_short | Orthostatic chronotropic incompetence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) |
| title_sort | orthostatic chronotropic incompetence in patients with myalgic encephalomyelitis chronic fatigue syndrome me cfs |
| topic | Orthostatic intolerance Tilt table testing ME/CFS Stroke volume index Cardiac index Chronotropic incompetence |
| url | http://www.sciencedirect.com/science/article/pii/S2667242123000374 |
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