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Naschitz, J.E. et al.

Naschitz, Rosner, Rozenbaum, Naschitz, Musafia-Priselac, Shaviv, Fields, Isseroff, Zuckerman, Yeshurun, Sabo,

The head-up tilt test with haemodynamic instability score in diagnosing chronic fatigue syndrome.

BACKGROUND: Studying patients with chronic fatigue syndrome (CFS), we have developed a method that uses a head-up tilt test (HUTT) to estimate BP and HR instability during tilt, expressed as a 'haemodynamic instability score' (HIS). Aim: To assess HIS sensitivity and specificity in the diagnosis of CFS. DESIGN:Prospective controlled study. METHODS: Patients with CFS (n=40), non-CFS chronic fatigue (n=73), fibromyalgia (n=41), neurally mediated syncope (n=58), generalized anxiety disorder (n=28), familial Mediterranean fever (n=50), arterial hypertension (n=28), and healthy subjects (n=59) were evaluated with a standardized head-up tilt test (HUTT). The HIS was calculated from blood pressure (BP) and heart rate (HR) changes during the HUTT. RESULTS: The tilt was prematurely terminated in 22% of CFS patients when postural symptoms occurred and the HIS could not be calculated. In the remainder, the median(IQR) HIS values were: CFS +2.14(4.67), non-CFS fatigue -3.98(5.35), fibromyalgia -2.81(2.62), syncope -3.7(4.36), generalized anxiety disorder -0.21(6.05), healthy controls -2.66(3.14), FMF -5.09(6.41), hypertensives -5.35(2.74) (p<0.0001 vs. CFS in all groups, except for anxiety disorder, p=NS). The sensitivity for CFS at HIS >-0.98 cut-off was 90.3% and the overall specificity was 84.5%. DISCUSSION: There is a particular dysautonomia in CFS that differs from dysautonomia in other disorders, characterized by HIS >-0.98. The HIS can reinforce the clinician's diagnosis by providing objective criteria for the assessment of CFS, which until now, could only be subjectively inferred.[1]

References

The head-up tilt test with haemodynamic instability score in diagnosing chronic fatigue syndrome. Naschitz, J.E., Rosner, I., Rozenbaum, M., Naschitz, S., Musafia-Priselac, R., Shaviv, N., Fields, M., Isseroff, H., Zuckerman, E., Yeshurun, D., Sabo, E. QJM : monthly journal of the Association of Physicians. (2003) [Pubmed]

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