http://www.clinsci.org/cs/122/0183/cs1220183.htm
[Hat tip: The CAA (@PlzSolveCFS on Twitter)]
Tom
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http://www.clinsci.org/cs/imps/abs/CS20110200.htm
Neurohumoral and Hemodynamic Profile in Postural Tachycardia and
Chronic Fatigue Syndromes
Clinical Science (2011) Immediate Publication, doi:10.1042/CS20110200
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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