Clinical Science (2011) Immediate Publication, doi:10.1042/CS20110200
Neurohumoral and Hemodynamic Profile in Postural Tachycardia and
Chronic Fatigue Syndromes
Luis E Okamoto, Satish R Raj, Amanda Catherine Peltier, Alfredo
Gamboa, Cyndya A Shibao, Andre Diedrich, Bonnie K Black, David
Robertson and Italo Biaggioni
Vanderbilt University School of Medicine, Nashville, U.S.A..
Italo.Biaggioni@Vanderbilt.edu
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. Ninety-three percent of them reported severe fatigue
(Checklist Individual Strength [CIS], fatigue subscale <36), and 64%
(n=3D30) 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=B14 vs. 33=B13, p=3D0.153), despite more severe fatigue i=
n
CFS-POTS patients (CIS fatigue subscale 51=B11 vs. 43=B13, p=3D0.016).
CFS-POTS patients had greater orthostatic tachycardia than the non-CFS
POTS group (51=B13 vs. 40=B14 bpm, p=3D0.030), greater low frequency
variability of blood pressure (6.3=B10.7 vs. 4.8=B11.0 mmHg2, p=3D0.019),
greater BP recovery from early to late phase II of the Valsalva
maneuver (18=B13 vs. 11=B12 mmHg, p=3D0.041), and a higher supine (1.5=B10.=
2
vs. 1.0=B10.3 ng/mL/h; p=3D0.033) and upright (5.4=B10.6 vs. 3.5=B10.8
ng/mL/h; p=3D0.032) plasma renin activity. In conclusion, 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.
Received 19 April 2011/15 July 2011; Accepted 12 September 2011
Published as Immediate Publication 12 September 2011
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