The head-up tilt test with haemodynamic instability score in diagnosing chronic fatigue syndrome

Naschitz, Jochanan E.; Rosner, Itzhak; Rozenbaum, Michael; Naschitz, Shaul; Musafia-Priselac, R; Shaviv, Naomi; Fields, Madeline; Isseroff, Hillel; Zuckerman, Elimelech; Yeshurun, Daniel; Sabo, Edmond

doi:10.1093/qjmed/hcg018

Cited by 19 publications

(10 citation statements)

References 43 publications

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“…In contradistinction, recent studies suggest that disease-related CVRs may exist. A disease-related CVR phenotype has been described in CFS [1][2][3][4][5][6] and another phenotype in patients with neurally mediated syncope [6]. The present study showed that an abnormal CVR exists in the large majority of FMF patients and is disease-specific.…”

Section: Discussionsupporting

confidence: 63%

Search for disease-specific cardiovascular reactivity patterns: developing the methodology

et al. 2004

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Aberrations of CVR (cardiovascular reactivity), an expression of autonomic function, lack specificity for a particular disorder. Recently, a CVR pattern particular to chronic fatigue syndrome has been observed. In the present study, we aimed to develop methodologies for assessing disease-specific CVR patterns. As a prototype, a population of 50 consecutive patients with FMF (familial Mediterranean fever) was studied and compared with control populations. A 10 min supine/30 min head-up tilt test with recording of the heart rate and blood pressure or the pulse transit time was performed. Five studies were conducted applying different methods. In each study, statistical analysis identified independent predictors of CVR in FMF. Based on regression coefficients of these predictors, a linear DS (discriminant score) was computed for every subject. Each study established an equation to assess CVR, calculate DS for FMF and determine the sensitivity and specificity of the DS cut-off. In each of the five studies, abnormal CVR was observed in FMF patients. The best accuracy (88% sensitivity and 90.1% specificity for FMF) was obtained by a method based on beat-to-beat heart rate and pulse transit time recordings. Data was processed by fractal and recurrence quantitative analysis with recordings in FMF patients compared with a mixed control population. Identification of disease-specific CVR patterns was possible with the methodologies described in the present study. In FMF, disease-specific CVR may be explained by the interplay between neuroendocrine loops specific to FMF with cardiovascular homoeostatic mechanisms. Recognition of disease-specific CVR patterns may advance the understanding of homoeostatic mechanisms and have implications in clinical practice.

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Section: Discussionsupporting

confidence: 63%

Search for disease-specific cardiovascular reactivity patterns: developing the methodology

et al. 2004

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“…However, a recent study by Naschitz et al (2003) did find a particular dysautonomia in CFS that differs significantly from dysautonomia in non-CFS fatigue, FM, syncope, hypertension, and healthy controls, but not in generalized anxiety disorder. In this study, the researchers computed blood pressure and heart rate changes during head-up tilt test and processed the data by image analysis methods, establishing a numerical expression as the hemodynamic instability score.…”

Section: Autonomic Nervous Systemmentioning

confidence: 77%

Chronic Fatigue Syndrome: The Need for Subtypes

et al. 2005

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Chronic fatigue syndrome (CFS) is an important condition confronting patients, clinicians, and researchers. This article provides information concerning the need for appropriate diagnosis of CFS subtypes. We first review findings suggesting that CFS is best conceptualized as a separate diagnostic entity rather than as part of a unitary model of functional somatic distress. Next, research involving the case definitions of CFS is reviewed. Findings suggest that whether a broad or more conservative case definition is employed, and whether clinic or community samples are recruited, these decisions will have a major influence in the types of patients selected. Review of further findings suggests that subtyping individuals with CFS on sociodemographic, functional disability, viral, immune, neuroendocrine, neurology, autonomic, and genetic biomarkers can provide clarification for researchers and clinicians who encounter CFS' characteristically confusing heterogeneous symptom profiles. Treatment studies that incorporate subtypes might be particularly helpful in better understanding the pathophysiology of CFS. This review suggests that there is a need for greater diagnostic clarity, and this might be accomplished by subgroups that integrate multiple variables including those in cognitive, emotional, and biological domains.

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“…Orthostatic intolerance, an umbrella term that includes the conditions of neurally mediated hypotension and postural orthostatic tachycardia syndrome, commonly occurs with CFS, particularly among adolescents 27–30 . Neurally mediated hypotension occurs when the autonomic nervous system, which controls heart rate and blood pressure response, misinterprets what the body needs during an upright posture and sends a message to the heart to slow down and lower the blood pressure, the opposite of what the body needs.…”

Section: Diagnosis Symptoms and Comorbid Conditionsmentioning

confidence: 99%

“…Factors that cause orthostatic intolerance in CFS are poorly understood and may include complex interactions between adrenal hormones, HPA‐axis dysregulation, and autonomic dysfunction of heart rate, heart muscle contraction and relaxation, peripheral vasodilation and constriction, reduced cerebral perfusion, and volume depletion 27 . Cardiology testing with the tilt‐table test can aid in the diagnosis of orthostatic intolerance with CFS 28,30 …”

Section: Diagnosis Symptoms and Comorbid Conditionsmentioning

confidence: 99%

Chronic Fatigue Syndrome: Implications for Women and their Health Care Providers During the Childbearing Years

Allen¹

2008

J Midwife Womens Health

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Chronic fatigue syndrome is a complex debilitating medical disorder that affects approximately 4 million persons in the United States, predominantly women. There has been little scientific exploration about the experience of pregnancy, childbirth, and the postpartum period for women with this disorder. A review of the literature and current research findings addressing the epidemiology, diagnosis, symptoms, and treatment of chronic fatigue syndrome are presented, as well as the currently available data regarding the experience of women with chronic fatigue syndrome anticipating or experiencing pregnancy and the postpartum period. Expert opinion is presented along with current evidence to provide guidelines for the care of women with chronic fatigue syndrome during pregnancy, labor and birth, lactation, and the postpartum period.

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The head-up tilt test with haemodynamic instability score in diagnosing chronic fatigue syndrome

Abstract: There is a particular dysautonomia in CFS that differs from dysautonomia in other disorders, characterized by HIS >-0.98. The HIS can reinforce the clinician's diagnosis by providing objective criteria for the assessment of CFS, which until now, could only be subjectively inferred.

Cited by 19 publications

References 43 publications

Search for disease-specific cardiovascular reactivity patterns: developing the methodology

Search for disease-specific cardiovascular reactivity patterns: developing the methodology

Chronic Fatigue Syndrome: The Need for Subtypes

Chronic Fatigue Syndrome: Implications for Women and their Health Care Providers During the Childbearing Years

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