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Hemodynamics instability score in chronic fatigue syndrome and in non-chronic fatigue syndrome
Jochanan E Naschitz1, Edmond Sabo, Shaul Naschitz
1Departments of Internal Medicine A, Rheumatology, Anesthesiology, and Surgery, Bnai Zion Medical Center and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Insights
Chronic Fatigue Syndrome (CFS) patients exhibit significant hemodynamic instability, identified by a high hemodynamic instability score (HIS). This objective measure, HIS >-0.98, aids in diagnosing CFS.
Area of Science:
- Cardiology
- Neurology
- Internal Medicine
Background:
- Chronic Fatigue Syndrome (CFS) is a complex condition with poorly understood pathophysiology.
- Cardiovascular autonomic dysfunction is increasingly recognized as a contributing factor in CFS.
- Objective markers are needed to differentiate CFS from other fatiguing illnesses.
Purpose of the Study:
- To introduce and validate the hemodynamic instability score (HIS) as a quantitative measure of cardiovascular lability.
- To compare HIS in patients with CFS, non-CFS chronic fatigue, and recurrent syncope.
- To assess the diagnostic utility of HIS in identifying CFS.
Main Methods:
- A standardized head-up tilt test (HUTT) was performed on patients with CFS (n=21), non-CFS chronic fatigue (n=24), syncope (n=44), and healthy controls (n=21).
- Cardiovascular responses were assessed, and abnormal reactions were classified as clinical outcomes or HIS endpoints (HIS >-0.98).
- The hemodynamic instability score (HIS) was calculated to quantify blood pressure and heart rate lability.
Main Results:
- CFS patients exhibited the highest incidence of abnormal HUTT endpoints (79%), including presyncope or syncope (38%).
- The average HIS was significantly higher in CFS patients (+2.02) compared to non-CFS chronic fatigue (-2.89), syncope (-3.2), and healthy controls (-2.48).
- CFS patients were significantly more likely to have an HIS >-0.98 (Odds Ratios ranging from 8.8 to 34.8) compared to other groups.
Conclusions:
- CFS shares some cardiovascular reactivity patterns with syncope and non-CFS chronic fatigue, such as vasodepressor and cardioinhibitory reactions.
- A distinct abnormality, characterized by HIS values >-0.98, is prevalent in the majority of CFS patients.
- The hemodynamic instability score (HIS) provides objective criteria for the assessment and diagnosis of CFS.
Objective:
In studying patients with chronic fatigue syndrome (CFS) we developed a method that confers numerical expression to the degree of blood pressure and heart rate lability, ie, the 'hemodynamic instability score' (HIS). The HIS in CFS patients differed significantly from healthy subjects. The present investigation compares the HIS in CFS, non-CFS chronic fatigue and patients with recurrent syncope.
Methods:
Patients with CFS (n = 21), non-CFS chronic fatigue (n = 24), syncope of unknown cause (n = 44), and their age and sex-matched healthy controls (n = 21) were evaluated with a standardized head-up tilt test (HUTT). Abnormal reactions (endpoints) on HUTT were classified 'clinical outcomes' (cardioinhibitory or vasodepressor reaction, orthostatic hypotension, postural tachycardia syndrome) and 'HIS endpoint', i.e. HIS >-0.98.
Results:
The highest incidence of endpoints was noted in patients with CFS (79%), followed by patients with syncope of unknown cause (46%), non-CFS chronic fatigue (35%), and healthy subjects (14%). Presyncope or syncope during tilt occurred in 38% of CFS patients, 21% of patients with non-CFS chronic fatigue, and 43% of patients with recurrent syncope. The average HIS values were: CFS = +2.02 (SD 4.07), non-CFS chronic fatigue = -2.89 (SD 3.64), syncope = -3.2 (SD 3.0), healthy = -2.48 (4.07). The odds ratios for CFS patients to have HIS >-0.98 was 8.8 compared with non-CFS chronic fatigue patients, 14.6 compared with recurrent syncope patients, and 34.8 compared with healthy subjects.
Conclusion:
The cardiovascular reactivity in patients with CFS has certain features in common with the reactivity in patients with recurrent syncope or non-CFS chronic fatigue, such as the frequent occurrence of vasodepressor reaction, cardioinhibitory reaction, and postural tachycardia syndrome. Apart from to these shared responses, the large majority of CFS patients exhibit a particular abnormality which is characterized by HIS values >-0.98. Thus, HIS >-0.98 lends objective criteria to the assessment of CFS.
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