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Impaired cardiovascular response to standing in Chronic Fatigue Syndrome

Lookup NU author(s): Dr Kieren Hollingsworth, Professor David Jones, Professor Roy Taylor, Professor Andrew BlamireORCiD, Emerita Professor Julia Newton


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P>Background Impaired skeletal muscle metabolism is recognized in chronic fatigue syndrome (CFS). This study examined the relationship between skeletal and cardiac muscle function and symptoms on standing in CFS using magnetic resonance spectroscopy (MRS) and impedance cardiography. Materials and methods Phosphocreatine (PCr)/adenosine triphosphate (ATP) ratio by cardiac MRS, PCr/ADP and proton efflux by muscle MRS were performed in 12 CFS (Fukuda) and 8 controls. Head up tilt (HUT) and cardiac contractility (left ventricular work index, LVWI) (n = 64 CFS and matched controls) were found. Fatigue impact was accessed by Fatigue Impact Scale and orthostatic symptoms by Orthostatic Grading Scale (OGS). Results Cardiac PCr/ATP correlated with measures of muscle bioenergetic function (half-time PCr recovery [kappa = -0 center dot 71, P = 0 center dot 005] and half-time ADP recovery [kappa = -0 center dot 60, P = 0 center dot 02]) suggesting that the muscle and cardiac bioenergetic function correlate in CFS. Four of 12 (33 center dot 3%) CFS patients had PCr/ATP values consistent with significant cardiac impairment. Those with impaired cardiac energy metabolism had significantly reduced maximal and initial proton efflux rates (P < 0 center dot 05). Cardiac PCr/ATP ratio correlated with myocardial contractility (LVWI) in response to standing (P = 0 center dot 03). On HUT, LVWI on standing was significantly higher in CFS (P = 0 center dot 05) with symptoms on standing (OGS) occurring in 61/64 (95%) (vs. 25/64 [39%] controls; P < 0 center dot 0001). OGS scores were significantly higher in those with abnormal LVWI responses to standing (P = 0 center dot 04), with the LVWI on standing correlating with OGS scores (r2 = 0 center dot 1; P = 0 center dot 03). HUT was positive in 19 (32%). Conclusions Skeletal muscle and cardiac bioenergetic abnormalities associate in CFS. Cardiac bioenergetic metabolism associates with increase in cardiac contractility on standing. Haemodynamic assessment in CFS is well tolerated and safe with a high diagnostic yield comparable with unexplained syncope.

Publication metadata

Author(s): Hollingsworth KG, Jones DEJ, Taylor R, Blamire AM, Newton JL

Publication type: Article

Publication status: Published

Journal: European Journal of Clinical Investigation

Year: 2010

Volume: 40

Issue: 7

Pages: 608-615

Print publication date: 23/05/2010

ISSN (print): 0014-2972

ISSN (electronic): 1365-2362

Publisher: Wiley-Blackwell


DOI: 10.1111/j.1365-2362.2010.02310.x


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