26 September 2008
Journal: QJM. 2008 Sep 19. [Epub ahead of print]
Authors: Hoad A, Spickett G, Elliott J, Newton J.
Affiliations: From the Northern CFS/ME Clinical Network, Equinox
House, Silver Fox Way, Cobalt Business Park, Newcastle upon Tyne ME
NorthEast, Bullion Hall, County Durham and Falls and Syncope Service,
Institute of Cellular Medicine, Newcastle University, Newcastle, UK.
NLM Citation: PMID: 18805903
BACKGROUND: It has been suggested that postural orthostatic
tachycardia syndrome (POTS) be considered in the differential
diagnosis of those with chronic fatigue syndrome/myalgic
encephalomyelitis (CFS/ME). Currently, measurement of haemodynamic
response to standing is not recommended in the UK NICE CFS/ME
guidelines. Objectives: To determine prevalence of POTS in patients
with CFS/ME. Design: Observational cohort study.
METHODS: Fifty-nine patients with CFS/ME (Fukuda criteria) and 52
age- and sex-matched controls underwent formal autonomic assessment
in the cardiovascular laboratory with continuous heart rate and
beat-to-beat blood pressure measurement (Task Force, CNSystems, Graz
Austria). Haemodynamic responses to standing over 2 min were
measured. POTS was defined as symptoms of orthostatic intolerance
associated with an increase in heart rate from the supine to upright
position of >30 beats per minute or to a heart rate of >120 beats per
minute on standing.
RESULTS: Maximum heart rate on standing was significantly higher in
the CFS/ME group compared with controls (106 +/- 20 vs. 98 +/- 13; P
= 0.02). Of the CFS/ME group, 27% (16/59) had POTS compared with 9%
(5) in the control population (P = 0.006). This difference was
predominantly related to the increased proportion of those in the
CFS/ME group whose heart rate increased to >120 beats per minute on
standing (P = 0.0002). Increasing fatigue was associated with
increase in heart rate (P = 0.04; r(2) = 0.1).
CONCLUSION: POTS is a frequent finding in patients with CFS/ME. We
suggest that clinical evaluation of patients with CFS/ME should
include response to standing. Studies are needed to determine the
optimum intervention strategy to manage POTS in those with CFS/ME.