Chronic Fatigue Syndrome and Cardiovascular Disease: JACC State-of-the-Art Review

[nerd]

Natelson BH, Brunjes DL, Mancini D. Chronic Fatigue Syndrome and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021 Sep 7;78(10):1056-1067
doi: 10.1016/j.jacc.2021.06.045
PMID: 34474739

Abstract

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a medically unexplained illness characterized by severe fatigue limiting normal daily activities for at least 6 months accompanied by problems with unrefreshing sleep, exacerbation of symptoms following physical or mental efforts (postexertional malaise [PEM]), and either cognitive reports or physiological evidence of orthostatic intolerance in the form of either orthostatic tachycardia and/or hypocapnia. Although rarely considered to have cardiac dysfunction, ME/CFS patients frequently have reduced stroke volume with a significant inverse relation between cardiac output and PEM severity. Magnetic resonance imaging of ME/CFS patients compared with normal control subjects found significantly reduced stroke, end-systolic, and end-diastolic volumes together with reduced end-diastolic wall mass. Another cardiovascular abnormality is reduced nocturnal blood pressure assessed by 24-hour monitoring. Autonomic dysfunction is also frequently observed with postural orthostatic tachycardia and/or hypocapnia. Two consecutive cardiopulmonary stress tests may provide metabolic data substantiating PEM.

 

[Pyrrhus]

Thanks so much for posting this (Natelson et al., 2021) paper!

I would love to hear what David Systrom would have to say about this conclusion:

ME/CFS patients frequently have reduced stroke volume with a significant inverse relation between cardiac output and PEM severity.

Many people make the mistake of confusing exercise intolerance with PEM, so it is important to clarify that David Systrom found dysautonomic control of cardiac output during exercise intolerance, but the above conclusion talks about dysautonomic control of cardiac output during PEM.

Ben Natelson is an absolutely lovely person and a longtime devoted ME/CFS advocate, but his mentions of deconditioning and depression seem a bit out of place in this article...

 

[Rufous McKinney]

but his mentions of deconditioning and depression seem a bit out of place in this article...

maybe some peer reviewer pushed the remarks upon them....

 

[nerd]

maybe some peer reviewer pushed the remarks upon them....

It's even in their chart. PTSD as well.

 

[wabi-sabi]

Aren't you always going to have decreased stroke volume in someone who's hypovolemic?

OK, I haven't read the article, but I'm not impressed by the abstract. They call ME/CFS a MUS, which it clearly isn't and it doesn't feel like they are up on current research like Dr. Systrom's. It just seems like most of their markers- decreased stroke volume, low nighttime BP, and low end-diastolic and low end-systolic stroke volumes could be explained as symptoms of the neuro issues and low blood volume, without a cardiac problems at all. Confusing cause and effect as it were.

 

[wabi-sabi]

Their concept map certainly mischaracterizes the role of deconditioning and psych issues in the development of ME/CFS. This suggests they are not in touch with current ME/CFS research. They seem unclear about the relationship of fibro to ME/CFS and downplay the role of volume depletion.

If this is the current concept of ME/CFS we have a lot of work to do!