Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography

Clinical Neurophysiology Practice
C Linda M C van CampenFrans C Visser

Abstract

The underlying hypothesis in orthostatic intolerance (OI) syndromes is that symptoms are associated with cerebral blood flow (CBF) reduction. Indirect CBF measurements (transcranial Doppler flow velocities), provide inconsistent support of this hypothesis. The aim of the study was to measure CBF during a 30 min head-up tilt test (HUT), using Doppler flow imaging of carotid and vertebral arteries, in individuals with chronic fatigue syndrome/myalgic encephalomyelitis (ME/CFS), a condition with a high prevalence of OI. 429 ME/CFS patients were studied: 247 had a normal heart rate (HR) and blood pressure (BP) response to HUT, 62 had delayed orthostatic hypotension (dOH), and 120 had postural orthostatic tachycardia syndrome (POTS). We also studied 44 healthy controls (HC). CBF measurements were made at mid-tilt and end-tilt. Before mid-tilt, we administered a verbal questionnaire to ascertain for 15 OI symptoms. End-tilt CBF reduction was 7% in HC versus 26% in the overall ME/CFS group, 24% in patients with a normal HR/BP response, 28% in those with dOH, and 29% in POTS patients (all P < .0005). Using a lower limit of normal of 2SD of CBF reduction in HC (13% reduction), 82% of patients with normal HR/BP response, 98% with dOH and...Continue Reading

Citations

Apr 23, 2021·Journal of Translational Medicine·Klaus J Wirth, Carmen Scheibenbogen
May 6, 2021·Journal of Translational Medicine·C Linda M C van CampenFrans C Visser
May 18, 2021·Frontiers in Medicine·Lindsay S PetracekPeter C Rowe
Jul 16, 2021·The Journal of Clinical Investigation·Øystein FlugeOlav Mella
Aug 30, 2021·Mayo Clinic Proceedings·Lucinda BatemanBrayden P Yellman
Sep 4, 2021·Journal of the American College of Cardiology·Benjamin H NatelsonDonna Mancini

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