Cerebral and Systemic Hemodynamics Changes During Upright Tilt in Chronic Fatigue Syndrome

Razumovsky, Alexander Y.; DeBusk, Karen; Calkins, Hugh; Snader, Sally; Lucas, Katherine E.; Vyas, Pranav; Hanley, Daniel F.; Rowe, Peter C.

doi:10.1111/j.1552-6569.2003.tb00158.x

Cited by 33 publications

(18 citation statements)

References 39 publications

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“…First, contrary to our hypothesis, patients with POTS did not have impaired cerebral perfusion compared with normal control subjects, despite the presence of a cardiovascular profile during HUT, suggestive of increased orthostatic stress. In this regard, our data confirm the observations of others who did not observe reductions in CBV during orthostatic stress in POTS (22,38) and are not consistent with other studies in which CBV was excessively reduced during HUT (23,34).…”

Section: Discussionsupporting

confidence: 65%

“…The changes in cerebral perfusion during standing in patients with POTS have been measured using transcranial Doppler sonography of the middle cerebral artery (MCA). Some investigators did find that MCA cerebral blood velocity (CBV) decreased excessively during orthostatic stress (23,34), whereas others found no such change in CBV, despite the presence of symptoms suggestive of cerebral hypoperfusion (22,38). The reduction in CBV during orthostatic stress has been attributed to excessive hyperventilation (34) or to exaggerated sympathetic activity directed to cerebral vasculature (28).…”

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confidence: 99%

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Cerebral autoregulation is preserved in postural tachycardia syndrome

Schondorf¹,

Benoit²,

Stein³

2005

Journal of Applied Physiology

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autoregulation is preserved in postural tachycardia syndrome. J Appl Physiol 99: 828 -835, 2005. First published April 28, 2005 doi:10.1152/japplphysiol.00225.2005.-To test whether cerebral autoregulation is impaired in patients with postural tachycardia syndrome (POTS), we evaluated 17 healthy control subjects and 27 patients with POTS. Blood pressure, heart rate, and cerebral blood velocity (transcranial Doppler) were recorded at rest and during 80°h ead-up tilt (HUT). Static cerebral autoregulation, as assessed from the change in cerebrovascular resistance during HUT, was the same in POTS and in controls. The properties of dynamic cerebral autoregulation were inferred from transfer gain, coherence, and phase of the relationship between blood pressure and cerebral blood velocity estimated from filtered data segments (0.02-0.8 Hz). Dynamic cerebral autoregulation of patients with POTS did not differ from that of controls. The patients' dynamic cerebral autoregulation did not change over the course of HUT, despite increased tachycardia suggestive of worsening orthostatic stress. Inflation of military anti-shock trouser pants substantially reduced the tachycardia of patients with POTS without affecting cerebral autoregulation. Symptoms of orthostatic intolerance were reduced in one-half of the patients following military anti-shock trouser pants inflation. We conclude that cerebral perfusion and autoregulation in many patients with POTS do not differ from that of normal control subjects. cerebrovascular circulation; Fourier analysis; hemodynamics THE POSTURAL ORTHOSTATIC TACHYCARDIA syndrome (POTS) is a form of orthostatic intolerance that is characterized by symptoms of lightheadedness, fatigue, palpitations, diminished concentration, blurred vision, tremulousness, shortness of breath, nausea, and impaired cognition that mainly occur during upright posture (5,24,31,33). To qualify for the diagnosis of POTS, these symptoms must occur in conjunction with an increase in heart rate (HR) of Ͼ30 beats/min or a HR Ͼ 120 beats/min within the first 5 min of standing (23)(24)(25)31). The HR increase should be sustained and not associated with orthostatic hypotension (46). Many patients have evidence of hypovolemia (16,26) or exaggerated venous pooling with central hypovolemia (32,48). Inflation of military anti-shock trousers (MAST pants), which prevent venous pooling in the legs, usually causes reversal of the tachycardia (49). The pathophysiology of POTS is poorly understood. Various abnormalities have been described, including the presence of an attenuated autonomic neuropathy (25, 43), increased cardiac norepinephrine spillover (19), impaired norepinephrine transporter (45), or reduced vagal cardiac baroreflex sensitivity (14). Some patients may have evidence of increased sympathetic activity while supine (17, 18), whereas others do not (5).Regardless of pathophysiology, all patients with POTS are significantly disabled by the constellation of symptoms noted above (2).Lightheadedness and impaired concentration while ...

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Section: Discussionsupporting

confidence: 65%

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confidence: 99%

Cerebral autoregulation is preserved in postural tachycardia syndrome

Schondorf¹,

Benoit²,

Stein³

2005

Journal of Applied Physiology

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“…However, work by Fischler et al [27] and MacHale et al [28] could not confirm any deficits in CFS cerebral perfusion. Additionally, a study by Rowe and co-workers [29] using transcranial Doppler sonography did not find any differences in CBFV (cerebral blood flow velocity) between CFS and control subjects during upright tilt. The results of these measurements of cerebral perfusion in CFS/POTS are controversial, and these differences may be methodological.…”

Section: Introductionmentioning

confidence: 91%

Increasing orthostatic stress impairs neurocognitive functioning in chronic fatigue syndrome with postural tachycardia syndrome

et al. 2011

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CFS (chronic fatigue syndrome) is commonly co-morbid with POTS (postural tachycardia syndrome). Individuals with CFS/POTS experience unrelenting fatigue, tachycardia during orthostatic stress and ill-defined neurocognitive impairment, often described as ‘mental fog’. We hypothesized that orthostatic stress causes neurocognitive impairment in CFS/POTS related to decreased CBFV (cerebral blood flow velocity). A total of 16 CFS/POTS and 20 control subjects underwent graded tilt table testing (at 0, 15, 30, 45, 60 and 75°) with continuous cardiovascular, cerebrovascular, and respiratory monitoring and neurocognitive testing using an n-back task at each angle. The n-back task tests working memory, concentration, attention and information processing. The n-back task imposes increasing cognitive challenge with escalating (0-, 1-, 2-, 3- and 4-back) difficulty levels. Subject dropout due to orthostatic presyncope at each angle was similar between groups. There were no n-back accuracy or RT (reaction time) differences between groups while supine. CFS/POTS subjects responded less correctly during the n-back task test and had greater nRT (normalized RT) at 45, 60 and 75°. Furthermore, at 75° CFS/POTS subjects responded less correctly and had greater nRT than controls during the 2-, 3- and 4-back tests. Changes in CBFV were not different between the groups and were not associated with n-back task test scores. Thus we conclude that increasing orthostatic stress combined with a cognitive challenge impairs the neurocognitive abilities of working memory, accuracy and information processing in CFS/POTS, but that this is not related to changes in CBFV. Individuals with CFS/POTS should be aware that orthostatic stress may impair their neurocognitive abilities.

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“…16 While these perfusion deficits are either absent or different in comorbid illnesses such as depression, 21, 22 not all studies have identified neural perfusion abnormalities in CFS. 23 Also, like the MRI methodologies, the detection of these abnormalities may be expensive and difficult to implement. Continued research into the presence of perfusion abnormalities in a subset of patients with CFS may be useful in characterizing a neurological subtype of the illness, and in developing treatment strategies (e.g., increasing blood volume to restore cerebral perfusion).…”

Section: Neurological Biomarkers Of Cfs (Table 1)mentioning

confidence: 99%

“…In the neurological domain, many of these biomarkers lack specificity for CFS, are highly varied between patients with CFS, or require technological methods whose expense and complexity limit practical clinical application (e.g., fMRI). 23 In the immunological domain, diurnal variations in inflammatory markers make it difficult to draw cause-effect conclusions and create quantitative parameters for prognostic evaluation. 39 Differences in results may be, at least in some reports, attributed to total or partial differences in methodologies.…”

Section: A Critical Review Of Biomarkers For Cfs: Limitations and Futmentioning

confidence: 99%

Chronic fatigue syndrome: the current status and future potentials of emerging biomarkers

Fischer

William

Strauss

et al. 2014

Fatigue: Biomedicine, Health & Behavior

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Chronic fatigue syndrome (CFS) remains an incompletely characterized illness, in part due to controversy regarding its definition, biological basis and diagnosis. Biomarkers are objective measures that may lead to improvements in our understanding of CFS by providing a more coherent and consistent approach to study, diagnosis and treatment of the illness. Such metrics may allow us to distinguish between CFS subtypes – each defined by characteristic biomarkers – currently conflated under the single, heterogeneous condition of CFS. These delineations, in turn, may guide more granular, focused, and targeted treatment strategies based on more precise characterizations of the illness. Here, we review potential CFS biomarkers related to neurological and immunological components of the illness, and discuss how these biomarkers may be used to move the field of CFS forward, emphasizing clinical utility and potential routes of future research.

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Cerebral and Systemic Hemodynamics Changes During Upright Tilt in Chronic Fatigue Syndrome

Abstract: The results of this study are not consistent with the hypothesis that patients with CFS have a distinctive pattern of MCA CBFV changes in response to orthostatic stress.

Cited by 33 publications

References 39 publications

Cerebral autoregulation is preserved in postural tachycardia syndrome

Cerebral autoregulation is preserved in postural tachycardia syndrome

Increasing orthostatic stress impairs neurocognitive functioning in chronic fatigue syndrome with postural tachycardia syndrome

Chronic fatigue syndrome: the current status and future potentials of emerging biomarkers

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