Hemodynamic instability score as a measure for CFS

[Guest guest]

1: Semin Arthritis Rheum. 2002 Dec;32(3):141-8.

Hemodynamics instability score in chronic fatigue syndrome and in

non-chronic fatigue syndrome.

Naschitz JE, Sabo E, Naschitz S, Rosner I, Rozenbaum M, Fields M,

Isseroff H, Priselac RM, Gaitini L, Eldar S, Zukerman E, Yeshurun D.

Departments 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.

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. Copyright 2002,

Elsevier Science (USA). All rights reserved.

PMID: 12528078 [PubMed - indexed for MEDLINE]