{"id":29761,"date":"2021-03-22T18:56:01","date_gmt":"2021-03-22T18:56:01","guid":{"rendered":"https:\/\/wames.org.uk\/cms-english\/?p=29761"},"modified":"2022-03-22T18:59:01","modified_gmt":"2022-03-22T18:59:01","slug":"insights-from-invasive-cardiopulmonary-exercise-testing-of-patients-with-me-cfs","status":"publish","type":"post","link":"https:\/\/wames.org.uk\/cms-english\/insights-from-invasive-cardiopulmonary-exercise-testing-of-patients-with-me-cfs\/","title":{"rendered":"Research: Insights from invasive cardiopulmonary exercise testing of patients with ME\/CFS"},"content":{"rendered":"

Insights from Invasive Cardiopulmonary Exercise Testing of Patients with Myalgic Encephalomyelitis\/ Chronic Fatigue Syndrome<\/a>, by Phillip Joseph,\u00a0Carlo Arevalo, Rudolf KF Oliveira, Donna Felsenstein, Anne Louise Oaklander, David M Systrom in<\/span> CHEST journal<\/em>\u00a0 Feb 09, 2021 [doi.org\/10.1016\/j.chest.2021.01.082]<\/p>\n

 <\/p>\n

Research abstract:<\/strong><\/h3>\n

Background<\/strong>
\nMyalgic encephalomyelitis\/chronic fatigue syndrome (ME\/CFS) affects tens of millions worldwide; the causes of exertional intolerance are poorly understood. The ME\/CFS label overlaps with postural orthostatic tachycardia (POTS) and fibromyalgia, and objective evidence of small fiber neuropathy (SFN) is reported in \u223c50% of POTS and fibromyalgia patients.<\/h3>\n

Research Question<\/strong>
\nCan invasive cardiopulmonary exercise testing (iCPET) and PGP9.5-immunolabeled lower-leg skin biopsies inform the pathophysiology of ME\/CFS exertional intolerance and potential relationships with SFN?<\/h3>\n

Study Design<\/strong> and Methods<\/h3>\n

We analyzed 1516 upright invasive iCPETs performed to investigate exertional intolerance. After excluding patients with intrinsic heart or lung disease and selecting those with right atrial pressures (RAP) <6.5 mmHg, results from 160 patients meeting ME\/CFS criteria who had skin-biopsy test results were compared to 36 controls. Rest-to-peak changes in cardiac output (Qc) were compared to oxygen uptake (Qc\/VO\u00a02\u00a0slope) to identify participants with low, normal, or high pulmonary blood flow by Qc\/VO\u00a02\u00a0tertiles.<\/h3>\n

Results<\/strong>
\nDuring exercise, the 160 ME\/CFS patients averaged lower RAP (1.9\u00b12 vs. 8.3\u00b11.5;\u00a0P<0.0001) and peak VO\u00a02\u00a0(80%\u00b121 vs. 101.4%\u00b117;\u00a0P<0.0001) than controls. The low-flow tertile had lower peak Qc than the normal and high-flow tertiles (88.4\u00b119% vs. 99.5\u00b123.8% vs. 99.9\u00b119.5% predicted;\u00a0P<0.01).<\/h3>\n

In contrast, systemic oxygen extraction was impaired in high-flow versus low and normal-flow participants (0.74\u00b10.1% vs. 0.88\u00b10.11 vs. 0.86\u00b10.1;\u00a0P<0.0001) in association with peripheral left-to-right shunting. Among the 160 ME\/CFS patient biopsies, 31% was consistent with SFN (epidermal innervation \u22645.0% of predicted;\u00a0P\u00a0< 0.0001). Denervation severity did not correlate with exertional measures.<\/h3>\n

Interpretation<\/strong>
\nThese results identify two types of peripheral neurovascular dysregulation that are biologically plausible contributors to ME\/CFS exertional intolerance\u2013depressed Qc from impaired venous return, and impaired peripheral oxygen extraction. In patients with small-fiber pathology, neuropathic dysregulation causing microvascular dilation may limit exertion by shunting oxygenated blood from capillary beds and reducing cardiac return.<\/p>\n","protected":false},"excerpt":{"rendered":"

Insights from Invasive Cardiopulmonary Exercise Testing of Patients with Myalgic Encephalomyelitis\/ Chronic Fatigue Syndrome, by Phillip Joseph,\u00a0Carlo Arevalo, Rudolf KF Oliveira, Donna Felsenstein, Anne Louise Oaklander, David M Systrom in CHEST journal\u00a0 Feb 09, 2021 [doi.org\/10.1016\/j.chest.2021.01.082]   Research abstract: Background … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[679,5295,6607,6609,2883,6610,6608,251,1134,3956,332,331,6611,2119],"class_list":["post-29761","post","type-post","status-publish","format-standard","hentry","category-news","tag-cardiopulmonary-exercise-tests","tag-donna-felsenstein","tag-dr-anne-louise-oaklander","tag-dr-carlo-arevalo","tag-dr-david-systrom","tag-dr-phillip-joseph","tag-dr-rudolf-rk-oliveira","tag-fibromyalgia","tag-fms","tag-icpet","tag-postural-orthostatic-tachycardia-syndrome","tag-pots","tag-sfn","tag-small-fiber-neuropathy"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p5qkYK-7K1","_links":{"self":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/29761","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/comments?post=29761"}],"version-history":[{"count":7,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/29761\/revisions"}],"predecessor-version":[{"id":34664,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/29761\/revisions\/34664"}],"wp:attachment":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/media?parent=29761"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/categories?post=29761"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/tags?post=29761"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}