Impaired cardiovascular response to standing in Chronic Fatigue Syndrome
Impaired cardiovascular response to standing in Chronic Fatigue Syndrome
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DOI：
10.1111/j.1365-2362.2010.02310.x
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发表时间：
2010-07-01
影响因子：
5.5
通讯作者：
Newton, Julia L.
中科院分区：
文献类型：
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作者：
Hollingsworth, Kieren G.;Jones, David E. J.;Newton, Julia L.
背景慢性疲劳综合征（CFS）是一种骨骼肌代谢异常的综合征.本研究采用磁共振波谱（MRS）和心阻抗图（Cardiac Impedance）技术，检测了12例CFS（Fukuda）患者和8例对照者的骨骼肌和心肌功能与站立症状的关系。头高位倾斜（HUT）和心肌收缩力（左心室作功指数，LVWI）采用疲劳影响量表（Fatigue Impact Scale，CFS）评定疲劳影响，采用立位分级量表（OGS）评定立位症状（半时PCr恢复[kappa = -0中心点71，P = 0中心点005]和半时ADP恢复[kappa = -0中心点60，P = 0中心点02]）表明CFS中肌肉和心脏生物能量功能相关。12例CFS患者中有4例（33例中心点3%）的PCr/ATP值与显著心脏损害一致。心脏能量代谢受损的患者最大质子流出率和初始质子流出率显著降低（P < 0，中心点05）。心脏PCr/ATP比值与站立时的心肌收缩力（LVWI）相关（P = 0，中心点03）。在HUT上，CFS患者站立时LVWI显著较高（P = 0，中心点05），61/64（95%）患者出现站立时症状（OGS）（与对照组25/64 [39%]相比; P < 0，中心点0001）。站立时LVWI反应异常的患者OGS评分显著较高（P = 0，中心点04），站立时LVWI与OGS评分相关（r2 = 0，中心点1; P = 0，中心点03）。HUT阳性19例（32%）。结论CFS患者存在骨骼肌和心脏生物能量异常。心脏生物能量代谢与站立时心脏收缩力的增加有关。CFS的血流动力学评估耐受性良好，安全性高，诊断率与不明原因晕厥相当。
P>BackgroundImpaired skeletal muscle metabolism is recognized in chronic fatigue syndrome (CFS). This study examined the relationship between skeletal and cardiac muscle function and symptoms on standing in CFS using magnetic resonance spectroscopy (MRS) and impedance cardiography.Materials and methodsPhosphocreatine (PCr)/adenosine triphosphate (ATP) ratio by cardiac MRS, PCr/ADP and proton efflux by muscle MRS were performed in 12 CFS (Fukuda) and 8 controls. Head up tilt (HUT) and cardiac contractility (left ventricular work index, LVWI) (n = 64 CFS and matched controls) were found. Fatigue impact was accessed by Fatigue Impact Scale and orthostatic symptoms by Orthostatic Grading Scale (OGS).ResultsCardiac PCr/ATP correlated with measures of muscle bioenergetic function (half-time PCr recovery [kappa = -0 center dot 71, P = 0 center dot 005] and half-time ADP recovery [kappa = -0 center dot 60, P = 0 center dot 02]) suggesting that the muscle and cardiac bioenergetic function correlate in CFS. Four of 12 (33 center dot 3%) CFS patients had PCr/ATP values consistent with significant cardiac impairment. Those with impaired cardiac energy metabolism had significantly reduced maximal and initial proton efflux rates (P < 0 center dot 05). Cardiac PCr/ATP ratio correlated with myocardial contractility (LVWI) in response to standing (P = 0 center dot 03). On HUT, LVWI on standing was significantly higher in CFS (P = 0 center dot 05) with symptoms on standing (OGS) occurring in 61/64 (95%) (vs. 25/64 [39%] controls; P < 0 center dot 0001). OGS scores were significantly higher in those with abnormal LVWI responses to standing (P = 0 center dot 04), with the LVWI on standing correlating with OGS scores (r2 = 0 center dot 1; P = 0 center dot 03). HUT was positive in 19 (32%).ConclusionsSkeletal muscle and cardiac bioenergetic abnormalities associate in CFS. Cardiac bioenergetic metabolism associates with increase in cardiac contractility on standing. Haemodynamic assessment in CFS is well tolerated and safe with a high diagnostic yield comparable with unexplained syncope.