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Cited by 89Cardiovascular Syncope and Autonomic DisordersFibromyalgia and Chronic Fatigue Syndrome ResearchHeart Rate Variability and Autonomic Control

Neurohumoral and haemodynamic profile in postural tachycardia and chronic fatigue syndromes

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Okamoto, Luis E., Raj, Satish R., Peltier, Amanda, Gamboa, Alfredo, Shibao, Cyndya, Diedrich, André, Black, Bonnie K., Robertson, David +1 more·2012·Clinical Science
DOI 10.1042/cs20110200PMC PMC3203411
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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.

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  • Patients with POTS often have exercise intolerance, more than 90% have chronic fatigue, and at least half meet criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

    “Patients with POTS often have exercise intolerance, more than 90% have chronic fatigue and at least half meet criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).18”

    From Diagnosis and management of postural orthostatic tachycardia syndrome (2022) · cites this paper as [18]

    The Results report severe fatigue in 93% of the POTS patients, and the Discussion reports that 64% met CDC criteria for CFS. But severe fatigue is not the same as chronic fatigue: the Introduction gives a 48–77% chronic-fatigue prevalence in earlier POTS cohorts, and the Results say some patients’ fatigue lasted less than six months. The paper describes impaired physical functioning and exercise-related fatigue, but does not establish how often patients have exercise intolerance. Page numbers were not available in our copy. (LLM, conf=0.88)

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  • POTS and CFS may exist along the same clinical spectrum.

    “as such, they may exist along the same clinical spectrum (82).”

    From Postural Orthostatic Tachycardia Syndrome (2019) · cites this paper as [82]

  • Patients with POTS may simultaneously meet diagnostic criteria for migraine, hypermobile Ehlers-Danlos syndrome, mast cell activation syndrome, or chronic fatigue syndrome.

    “Patients with POTS may simultaneously meet the diagnostic criteria for migraine, hypermobile Ehlers-Danlos syndrome (hEDS), mast cell activation syndrome (MCAS) or chronic fatigue syndrome (CFS) (Kavi et al., 2016; McDonald et al., 2014; Okamoto et al., 2012; Shaw et al., 2019).”

    From Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1 (2021) · cites this paper as Okamoto et al., 2012

  • POTS patients have a high prevalence of chronic fatigue (48-77%) and of CFS (17-23%).

    “Patients with POTS have a high prevalence of chronic fatigue (48-77%) and of CFS (17-23%) [33;8].”

    From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [33]

  • Autonomic testing indicated a similar autonomic profile but higher sympathetic tone in POTS patients with CFS.

    “Autonomic testing indicated a similar autonomic profile but higher sympathetic tone in patients with CFS.”

    From Postural tachycardia syndrome: beyond orthostatic intolerance (2015) · cites this paper as [33]

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Authors
Okamoto, L. E., Raj, S. R., Peltier, A., Gamboa, A., Shibao, C., Diedrich, A., Black, B. K., Robertson, D., & Biaggioni, I.
Affiliations
Vanderbilt University (US)
Corresponding author
Biaggioni, Italo
ORCID
Venue
Clinical Science
Publisher
Portland Press Ltd.
Published
2011-10-24
Volume
122
Issue
4
Pages
183-192
ISSN
  • 0143-5221 (ISSN-L)
  • 1470-8736
DOI
10.1042/cs20110200
PMC
PMC3203411
OpenAlex
W2013070592
Cited by
89
References
41
Citations by year
2026: 1 · 2025: 2 · 2024: 8 · 2023: 10 · 2022: 7 · 2021: 7 · 2020: 7 · 2019: 7 · 2018: 10 · 2017: 5 · 2016: 5 · 2015: 4 · 2014: 6 · 2013: 4 · 2012: 5
FWCI
4.91
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Science (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Funders
  • Vanderbilt University
  • Centers for Disease Control and Prevention
  • National Heart, Lung, and Blood Institute (K23HL103976, P01HL056693, R01HL102387, P01 HL-56693)
  • National Institute of Neurological Disorders and Stroke (R01NS055670)
  • National Center for Research Resources (KL2RR024977, TL1RR024978, UL1RR024975)
  • NIH Clinical Center
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
postural orthostatic tachycardia syndrome, chronic fatigue syndrome, autonomic dysfunction, sympathetic activation, plasma renin activity, hemodynamics, orthostatic tachycardia, blood pressure variability, Valsalva maneuver, fatigue, physical function, pathophysiology, treatment goals
MeSH terms
Adult, Autonomic Nervous System, Blood Volume, Female, Humans, Norepinephrine, Sweating, Fatigue Syndrome, Chronic, Postural Orthostatic Tachycardia Syndrome

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