van Campen C Linda M C, Visser Frans C
Stichting CardioZorg, Kraayveld 5, 1171 JE Badhoevedorp, The Netherlands.
J Clin Med. 2025 May 22;14(11):3648. doi: 10.3390/jcm14113648.
: Orthostatic intolerance is prevalent in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and is caused by an abnormal reduction in cerebral blood flow (CBF). In healthy controls (HCs), CBF is regulated complexly, and cardiac output (CO) is an important determinant of CBF. A review in HC showed that a 30% reduction in CO results in a 10% reduction in CBF. In contrast, we showed in ME/CFS patients with a normal HR (HR) and blood pressure response during a tilt test that CO and CBF decreased to a similar extent. The relation between CO and CBF in ME/CFS patients with postural orthostatic tachycardia syndrome (POTS) is unknown. Therefore, the aim of this study is to assess the relation between CBF and CO, in ME/CFS patients with POTS. The methods used in this retrospective study analyze this relation in a large group of patients. We also analyzed the influence of clinical data. A total of 260 ME/CFS patients with POTS underwent tilt testing with measurements of HR, BP, CBF, CO, and end-tidal PCO. We measured CBF using extracranial Doppler flow velocity and vessel diameters obtained with a General Electric echo system, and suprasternal aortic flow velocities were measured using the same device. We recorded end-tidal PCO using a Nonin Lifesense device. : End-tilt HR and the HR increase were significantly higher in the patients with a %CO reduction ≥ -15% than in the other group. End-tilt CO was higher and the %CO reduction was lower in patients with %CO reduction ≥ -15% than in the other group. CBF data (supine, end-tilt and the %CBF reduction) were not different between the two patient groups. The use of HR increases and %SV reductions were not as discriminative as the %CO reduction. : In ME/CFS patients with POTS during tilt testing with measurements of both the CO and the CBF, two different patterns were observed: (1) appr. two-thirds of patients had an almost 1:1 relation between the %CBF reduction and the %CO reduction. (2) Appr. one-third of patients showed a limited reduction in CO together with a substantial increase in HR. In these patients, there was no relation between the CO and CBF reduction. These data suggest the presence of a hyperadrenergic response.
直立不耐受在肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）患者中很常见，由脑血流量（CBF）异常减少引起。在健康对照者（HCs）中，CBF受到复杂调节，心输出量（CO）是CBF的一个重要决定因素。对HCs的一项综述表明，CO降低30%会导致CBF降低10%。相比之下，我们发现倾斜试验期间心率（HR）和血压反应正常的ME/CFS患者中，CO和CBF下降幅度相似。姿势性直立性心动过速综合征（POTS）的ME/CFS患者中CO与CBF之间的关系尚不清楚。因此，本研究的目的是评估POTS的ME/CFS患者中CBF与CO之间的关系。这项回顾性研究中使用的方法在一大组患者中分析了这种关系。我们还分析了临床数据的影响。共有260例POTS的ME/CFS患者接受了倾斜试验，测量了HR、BP、CBF、CO和潮气末PCO。我们使用颅外多普勒流速和通用电气回声系统获得的血管直径测量CBF，使用同一设备测量胸骨上主动脉流速。我们使用Nonin Lifesense设备记录潮气末PCO。：CO降低百分比≥-15%的患者倾斜末期HR和HR增加显著高于另一组。CO降低百分比≥-15%的患者倾斜末期CO较高，CO降低百分比较低。两组患者的CBF数据（仰卧位、倾斜末期和CBF降低百分比）无差异。HR增加和每搏量（SV）降低百分比的判别能力不如CO降低百分比。：在倾斜试验期间同时测量CO和CBF的POTS的ME/CFS患者中，观察到两种不同模式：（1）约三分之二的患者CBF降低百分比与CO降低百分比之间几乎呈1:1关系。（2）约三分之一的患者CO降低有限，同时HR大幅增加。在这些患者中，CO降低与CBF降低之间没有关系。这些数据表明存在高肾上腺素能反应。
