Neurohumoral and haemodynamic profile in postural tachycardia and chronic fatigue syndromes

作者：Okamoto Luis E; Raj Satish R; Peltier Amanda; Gamboa Alfredo; Shibao Cyndya; Diedrich Andre; Black Bonnie K; Robertson David; Biaggioni Italo^*

来源：Clinical Science, 2012, 122(3-4): 183-192.

DOI：10.1042/CS20110200

• autonomic nervous system
• blood volume
• chronic fatigue syndrome
• orthostatic intolerance
• postural tachycardia syndrome (POTS)
• renin

Several studies recognized an overlap between CFS (chronic fatigue syndrome) and POTS (postural tachycardia syndrome). 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. A total of 93% of them reported severe fatigue [CIS (Checklist of Individual Strength), fatigue subscale >36], and 64% (n = 30) 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 +/- 4 compared with 33 +/- 3; P = 0.153), despite more severe fatigue in CFS POTS patients (CIS fatigue subscale 51 +/- 1 compared with 43 +/- 3; P = 0.016). CFS POTS patients had greater orthostatic tachycardia than the non-CFS POTS group (51 +/- 3 compared with 40 +/- 4 beats/min; P = 0.030), greater low-frequency variability of BP (blood pressure; 6.3 +/- 0.7 compared with 4.8 +/- 1.0 mmHg(2); P = 0.019), greater BP recovery from early to late phase 11 of the Valsalva manoeuvre (18 +/- 3 compared with 11 +/- 2 mmHg; P = 0.041) and a higher supine (1.5 +/- 0.2 compared with 1.0 +/- 0.3 ng/ml per. h; P = 0.033) and upright (5.4 +/- 0.6 compared with 3.5 +/- 0.8 ng/ml per h; P = 0.032) PRA (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.

• 出版日期2012-2