Effects of Post-Exertional Malaise on Markers of Arterial Stiffness in Individuals with ME/CFS (Bond et al., 2021)

[Pyrrhus]

Effects of Post-Exertional Malaise on Markers of Arterial Stiffness in Individuals with ME/CFS (Bond et al., 2021)
https://www.mdpi.com/1660-4601/18/5/2366/htm
by Joshua Bond, Tessa Nielsen and Lynette Hodges

Excerpt:

Background:
Evidence is emerging that individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) may suffer from chronic vascular dysfunction as a result of illness-related oxidative stress and vascular inflammation. The study aimed to examine the impact of maximal-intensity aerobic exercise on vascular function 48 and 72 h into recovery.

Methods:
ME/CFS (n = 11) with gender and age-matched controls (n = 11) were randomly assigned to either a 48 h or 72 h protocol. Each participant had measures of brachial blood pressure, augmentation index (AIx75, standardized to 75 bpm) and carotid-radial pulse wave velocity (crPWV) taken. This was followed by a maximal incremental cycle exercise test. Resting measures were repeated 48 or 72 h later (depending on group allocation).

Results:
No significant differences were found when ME/CFS were directly compared to controls at baseline. During recovery, the 48 h control group experienced a significant 7.2% reduction in AIx75 from baseline measures (p < 0.05), while the matched ME/CFS experienced no change in AIx75. The 72 h ME/CFS group experienced a non-significant increase of 1.4% from baseline measures. The 48 h and 72 h ME/CFS groups both experienced non-significant improvements in crPWV (0.56 ms−1 and 1.55 ms−1, respectively).

Conclusions:
The findings suggest that those with ME/CFS may not experience exercise-induced vasodilation due to chronic vascular damage, which may be a contributor to the onset of post-exertional malaise (PEM).

 

[Pyrrhus]

Terms used:

• augmentation pressure (AP)
• augmentation index (AIx75)
• pulse wave velocity (PWV)

I'm not familiar with the techniques used, but here is an excerpt from the introduction:

Arterial stiffness is a general term used to communally describe three main characteristics: compliance, distensibility and elastic modulus, in relation to the arterial vascular system. These arterial properties differ amongst location of the arterial tree, as blood vessels differ in size, muscle, and collagen/elastin content [15]. Increased measures of arterial stiffness have demonstrated to be a strong predictor for increased stroke, heart failure, atherosclerosis, myocardial infarction, and coronary artery disease, independent of blood pressure [16].

PWV is a systemic, non-invasive method of assessing arterial stiffness by determining the speed in which a pressure wave moves through the arterial system. AIx is the AP expressed as a percentage of central blood pressure, therefore being a combined measure of aortic wave reflection and systemic arterial stiffness [17]. A higher AIx therefore indicates an increase in arterial stiffness based on the higher returning speed and intensity of the reflected wave and is classified as an independent risk factor for CVD [18]. AIx is inversely related to heart rate, with a 10 bpm increase in heart rate accounting for a 4% reduction in AIx [19]. This means that AIx should be normalised for a heart rate of 75 bpm (AIx@HR75) to standardise data and prevent variation [19].

Assuming these techniques accurately measure arterial stiffness, I would think it is still a leap of reasoning to attribute a lack of exercise-induced circulatory changes to arterial stiffness alone.

 

[SlamDancin]

Thanks for posting this study!

 

[pattismith]

Conclusions

:
The findings suggest that those with ME/CFS may not experience exercise-induced vasodilation due to chronic vascular damage, which may be a contributor to the onset of post-exertional malaise (PEM).

if this is a correct assumption, then supplement that induce vasodilation may help with PEM.

Spices for example: pepper, mustards or cumin ;

These spices also have anti-inflammatory properties, so can be beneficial.

I had good result for PEM with Sinapis Alba seeds and @Wishful had good result with Cuminum Cyninum seeds;

I also use pepper and mustard powders locally to heal my skin inflammation/acne. (mustard is known to heal psoriasis)

The problem I had with Sinapis Alba was burning stomach and worsening of my erythromelalgia like symptoms in hands and feet (which is logical as it's a vasodilatory disorder).

Spices are well known foods to avoid if you suffer with erythromelalgia.

 

[Oliver3]

if this is a correct assumption, then supplement that induce vasodilation may help with PEM.

Spices for example: pepper, mustards or cumin ;

These spices also have anti-inflammatory properties, so can be beneficial.

I had good result for PEM with Sinapis Alba seeds and @Wishful had good result with Cuminum Cyninum seeds;

I also use pepper and mustard powders locally to heal my skin inflammation/acne. (mustard is known to heal psoriasis)

The problem I had with Sinapis Alba was burning stomach and worsening of my erythromelalgia like symptoms in hands and feet (which is logical as it's a vasodilatory disorder).

Spices are well known foods to avoid if you suffer with erythromelalgia.

It just gets worse...it's so deeply systemic.
I wonder if regenerative medicine is a viable option

 

[Luxintenebrislucet]

This makes me so depressed.
There is apparently nothing , that we can do to stopp this process.
Is it? I dont want to be rude, but so many sufferers say " great study" · great discover" but we are at the same point in terms of treatment than 30 years ago
So what do i get from this information. I know i cant do anything and i will die young.

 

[Rufous McKinney]

we are at the same point in terms of treatment than 30 years ago

I think we are getting somewhere, however its slow and when one is immersed in the experience, its hard to notice..that at least the SPECTOR of our challenge is a bit more clear.

And alot more folks are working on it.

I go to a chinese herbalist who is very good, and thats helped me more than most anything else ever has.

 

[Sushi]

Conclusions

:
The findings suggest that those with ME/CFS may not experience exercise-induced vasodilation due to chronic vascular damage, which may be a contributor to the onset of post-exertional malaise (PEM).

And, since some research (Berg) shows that we tend toward hypercoagulation, blood thinners could be even more important if these findings prove correct.

 

[Pyrrhus]

This makes me so depressed.
There is apparently nothing , that we can do to stopp this process.
Is it? I dont want to be rude, but so many sufferers say " great study" · great discover" but we are at the same point in terms of treatment than 30 years ago
So what do i get from this information. I know i cant do anything and i will die young.

I wouldn't get too upset over this study.

For one thing, I'm not convinced that their data really support their conclusion.

Secondly, there's no reason to believe that the endothelial dysfunction is irreversible...

 

[msf]

This makes me so depressed.
There is apparently nothing , that we can do to stopp this process.
Is it? I dont want to be rude, but so many sufferers say " great study" · great discover" but we are at the same point in terms of treatment than 30 years ago
So what do i get from this information. I know i cant do anything and i will die young.

Actually I have found there is something that can be done. I used to suffer a lot from what I assumed was reduced peripheral blood supply after exercise. I tried various ways of directly boosting this supply (such as taking l-argenine or small amounts of alcohol), but have since found that going after the energy problem itself with ALA and particularly Chinese skullcap has largely eliminated these symptoms and with it much or all of the PEM. My guess as to how this works is that my changing the energy use of the immune cells this also gets rid of some of the oxidative stress, which I believe has been shown in principle (albeit not in the context of ME).

 

[Pyrrhus]

Prior related study:

Low-grade inflammation and arterial wave reflection in patients with chronic fatigue syndrome (Spence et al., 2008)
https://pubmed.ncbi.nlm.nih.gov/18031285/

Discussion:
https://forums.phoenixrising.me/threads/uk-study-pediatric-cfs.6201/#post-130421

Excerpt:

Some of the symptoms reported by people with CFS (chronic fatigue syndrome) are associated with various cardiovascular phenomena. Markers of cardiovascular risk, including inflammation and oxidative stress, have been demonstrated in some patients with CFS, but little is known about the relationship between these and prognostic indicators of cardiovascular risk in this patient group.

In the present study, we investigated the relationship between inflammation and oxidative stress and augmentation index, a measure of arterial stiffness, in 41 well-characterized patients with CFS and in 30 healthy subjects.

AIx@75 (augmentation index normalized for a heart rate of 75 beats/min) was significantly greater in patients with CFS than in control subjects (22.5+/-1.7 compared with 13.3+/-2.3% respectively; P=0.002). Patients with CFS also had significantly increased levels of CRP (C-reactive protein) (2.58+/-2.91 compared with 1.07+/-2.16 mug/ml respectively; P<0.01) and 8-iso-prostaglandin F(2alpha) isoprostanes (470.7+/-250.9 compared with 331.1+/-97.6 pg/ml respectively; P<0.005). In patients with CFS, AIx@75 correlated significantly with logCRP (r=0.507, P=0.001), isoprostanes (r=0.366, P=0.026), oxidized LDL (low-density lipoprotein) (r=0.333, P=0.039) and systolic blood pressure (r=0.371, P=0.017). In a stepwise multiple regression model, including systolic and diastolic blood pressure, body mass index, CRP, tumour necrosis factor-alpha, interleukin-1, oxidized LDL, high-density lipoprotein-cholesterol levels, isoprostanes, age and gender, AIx@75 was independently associated with logCRP (beta=0.385, P=0.006), age (beta=0.363, P=0.022) and female gender (beta=0.302, P=0.03) in patients with CFS.

The combination of increased arterial wave reflection, inflammation and oxidative stress may result in an increased risk of future cardiovascular events. Assessment of arterial wave reflection might be useful for determining cardiovascular risk in this patient group.

 

[Oliver3]

I wouldn't get too upset over this study.

For one thing, I'm not convinced that their data really support their conclusion.

Secondly, there's no reason to believe that the endothelial dysfunction is irreversible...

That's a good perspective. Thanks

 

[Pyrrhus]

Terms used:

• augmentation pressure (AP)
• augmentation index (AIx75)
• pulse wave velocity (PWV)

I'm not familiar with the techniques used

I found a good paper that explains the techniques used:

Expert consensus document on arterial stiffness: methodological issues and clinical applications (Laurent et al., 2006)
https://academic.oup.com/eurheartj/article/27/21/2588/2887386

Basically, it says that Pulse Wave Velocity (PWV), when conducted correctly, is the most direct measure of arterial stiffness. Higher PWV means stiffer arteries.

The Augmentation Index (Alx75) is a standardized form of measuring Augmentation Pressure (AP). Higher Alx75 means stiffer arteries.