Neurohumoral and haemodynamic profile in postural tachycardia and chronic fatigue syndromes

Luis E Okamoto, Satish R Raj, Amanda Peltier, Alfredo Gamboa, Cyndya Shibao, André Diedrich, Bonnie K Black, David Robertson, Italo Biaggioni, Luis E Okamoto, Satish R Raj, Amanda Peltier, Alfredo Gamboa, Cyndya Shibao, André Diedrich, Bonnie K Black, David Robertson, Italo Biaggioni

Abstract

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 mmHg2; P=0.019), greater BP recovery from early to late phase II 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.

Figures

Figure 1. Prevalence of severe fatigue and…
Figure 1. Prevalence of severe fatigue and CFS-related symptoms
Severe fatigue was defined as a CIS fatigue severity subscale score >36. *P<0.05.
Figure 2. Orthostatic changes in (A) PRA,…
Figure 2. Orthostatic changes in (A) PRA, (B) plasma aldosterone and (C) the aldosterone/PRA ratio in patients with CFS and non-CFS–POTS
Control values from the Vanderbilt Autonomic Dysfunction Center database are included for reference. Values are expressed as means±S.E.M. The reported P values are for Mann–Whitney U tests comparing CFS–POTS with non-CFS–POTS patients.

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