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Hemodynamic and neurohumoral responses to head-up tilt in patients with chronic fatigue syndrome

Data on the prevalence of orthostatic intolerance (OI) in patients with chronic fatigue syndrome (CFS) are limited and controversial. We tested the hypothesis that a majority of CFS patients exhibit OI during head-up tilt. Hemodynamic and neurohumoral responses to 40 minutes of head-up tilt were stu...

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Published in:Clinical autonomic research 2002-08, Vol.12 (4), p.273-280
Main Authors: Timmers, H J L M, Wieling, W, Soetekouw, P M M B, Bleijenberg, G, Van Der Meer, J W M, Lenders, J W M
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container_title Clinical autonomic research
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creator Timmers, H J L M
Wieling, W
Soetekouw, P M M B
Bleijenberg, G
Van Der Meer, J W M
Lenders, J W M
description Data on the prevalence of orthostatic intolerance (OI) in patients with chronic fatigue syndrome (CFS) are limited and controversial. We tested the hypothesis that a majority of CFS patients exhibit OI during head-up tilt. Hemodynamic and neurohumoral responses to 40 minutes of head-up tilt were studied in 36 CFS patients and 36 healthy controls. Changes in stroke volume, cardiac output and peripheral vascular resistance were estimated from finger arterial pressure waveform analysis (Modelflow). Blood samples were drawn before and at the end of head-up tilt for measurement of plasma catecholamines. At baseline, supine heart rate was higher in CFS patients (CFS: 66.4 +/- 8.4 bpm; controls: 57.4 +/- 6.6 bpm; p < 0.001) as was the plasma epinephrine level (CFS: 0.11 +/- 0.07 nmol/l; controls: 0.08 +/- 0.07 nmol/l: p = 0.015). An abnormal blood pressure and/or heart rate response to head-up tilt was seen in 10 (27.8 %) CFS patients (6 presyncope, 2 postural tachycardia, 2 tachycardia and presyncope) and 6 (16.7 %, p = 0.26) controls (5 presyncope, 1 tachycardia, 2 tachycardia and presyncope). Head-up tilt-negative CFS patients showed a larger decrease in stroke volume during tilt (-46.9 +/- 10.6) than head-up tilt-negative controls (-40.3 +/- 13.6 %, p = 0.008). Plasma catecholamine responses to head-up tilt did not differ between these groups. Head-up tilt evokes postural tachycardia or (pre)syncope in a minority of CFS patients. The observations in head-up tilt-negative CFS patients of a higher heart rate at baseline together with a marked decrease in stroke volume in response to head-up tilt may point to deconditioning.
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Head-up tilt-negative CFS patients showed a larger decrease in stroke volume during tilt (-46.9 +/- 10.6) than head-up tilt-negative controls (-40.3 +/- 13.6 %, p = 0.008). Plasma catecholamine responses to head-up tilt did not differ between these groups. Head-up tilt evokes postural tachycardia or (pre)syncope in a minority of CFS patients. 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subjects Adult
Blood Pressure
Chronic fatigue syndrome
Epinephrine - blood
Fatigue Syndrome, Chronic - physiopathology
Fatigue Syndrome, Chronic - psychology
Female
Heart Rate
Humans
Male
Middle Aged
Norepinephrine - blood
Surveys and Questionnaires
Tilt-Table Test
title Hemodynamic and neurohumoral responses to head-up tilt in patients with chronic fatigue syndrome
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