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Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis.
Medicine (Baltimore). 2019 Oct; 98(43):e17600.M

Abstract

BACKGROUND

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex condition with no reliable diagnostic biomarkers. Studies have shown evidence of autonomic dysfunction in patients with ME/CFS, but results have been equivocal. Heart rate (HR) parameters can reflect changes in autonomic function in healthy individuals; however, this has not been thoroughly evaluated in ME/CFS.

METHODS

A systematic database search for case-control literature was performed. Meta-analysis was performed to determine differences in HR parameters between ME/CFS patients and controls.

RESULTS

Sixty-four articles were included in the systematic review. HR parameters assessed in ME/CFS patients and controls were grouped into ten categories: resting HR (RHR), maximal HR (HRmax), HR during submaximal exercise, HR response to head-up tilt testing (HRtilt), resting HR variability (HRVrest), HR variability during head-up tilt testing (HRVtilt), orthostatic HR response (HROR), HR during mental task(s) (HRmentaltask), daily average HR (HRdailyaverage), and HR recovery (HRR) Meta-analysis revealed RHR (MD ± 95% CI = 4.14 ± 1.38, P < .001), HRtilt (SMD ± 95% CI = 0.92 ± 0.24, P < .001), HROR (0.50 ± 0.27, P < .001), and the ratio of low frequency power to high frequency power of HRVrest (0.39 ± 0.22, P < .001) were higher in ME/CFS patients compared to controls, while HRmax (MD ± 95% CI = -13.81 ± 4.15, P < .001), HR at anaerobic threshold (SMD ± 95% CI = -0.44 ± 0.30, P = 0.005) and the high frequency portion of HRVrest (-0.34 ± 0.22, P = .002) were lower in ME/CFS patients.

CONCLUSIONS

The differences in HR parameters identified by the meta-analysis indicate that ME/CFS patients have altered autonomic cardiac regulation when compared to healthy controls. These alterations in HR parameters may be symptomatic of the condition.

Authors+Show Affiliations

Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia.Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia.Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia.Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia. Adelaide Medical School and Robinson Research Institute, University of Adelaide, Adelaide, Australia.Alliance for Research in Exercise, Nutrition and Activity (ARENA), University of South Australia.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

31651868

Citation

Nelson, Maximillian J., et al. "Evidence of Altered Cardiac Autonomic Regulation in Myalgic Encephalomyelitis/chronic Fatigue Syndrome: a Systematic Review and Meta-analysis." Medicine, vol. 98, no. 43, 2019, pp. e17600.
Nelson MJ, Bahl JS, Buckley JD, et al. Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(43):e17600.
Nelson, M. J., Bahl, J. S., Buckley, J. D., Thomson, R. L., & Davison, K. (2019). Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis. Medicine, 98(43), e17600. https://doi.org/10.1097/MD.0000000000017600
Nelson MJ, et al. Evidence of Altered Cardiac Autonomic Regulation in Myalgic Encephalomyelitis/chronic Fatigue Syndrome: a Systematic Review and Meta-analysis. Medicine (Baltimore). 2019;98(43):e17600. PubMed PMID: 31651868.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evidence of altered cardiac autonomic regulation in myalgic encephalomyelitis/chronic fatigue syndrome: A systematic review and meta-analysis. AU - Nelson,Maximillian J, AU - Bahl,Jasvir S, AU - Buckley,Jonathan D, AU - Thomson,Rebecca L, AU - Davison,Kade, PY - 2019/10/26/entrez PY - 2019/10/28/pubmed PY - 2019/11/5/medline SP - e17600 EP - e17600 JF - Medicine JO - Medicine (Baltimore) VL - 98 IS - 43 N2 - BACKGROUND: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex condition with no reliable diagnostic biomarkers. Studies have shown evidence of autonomic dysfunction in patients with ME/CFS, but results have been equivocal. Heart rate (HR) parameters can reflect changes in autonomic function in healthy individuals; however, this has not been thoroughly evaluated in ME/CFS. METHODS: A systematic database search for case-control literature was performed. Meta-analysis was performed to determine differences in HR parameters between ME/CFS patients and controls. RESULTS: Sixty-four articles were included in the systematic review. HR parameters assessed in ME/CFS patients and controls were grouped into ten categories: resting HR (RHR), maximal HR (HRmax), HR during submaximal exercise, HR response to head-up tilt testing (HRtilt), resting HR variability (HRVrest), HR variability during head-up tilt testing (HRVtilt), orthostatic HR response (HROR), HR during mental task(s) (HRmentaltask), daily average HR (HRdailyaverage), and HR recovery (HRR) Meta-analysis revealed RHR (MD ± 95% CI = 4.14 ± 1.38, P < .001), HRtilt (SMD ± 95% CI = 0.92 ± 0.24, P < .001), HROR (0.50 ± 0.27, P < .001), and the ratio of low frequency power to high frequency power of HRVrest (0.39 ± 0.22, P < .001) were higher in ME/CFS patients compared to controls, while HRmax (MD ± 95% CI = -13.81 ± 4.15, P < .001), HR at anaerobic threshold (SMD ± 95% CI = -0.44 ± 0.30, P = 0.005) and the high frequency portion of HRVrest (-0.34 ± 0.22, P = .002) were lower in ME/CFS patients. CONCLUSIONS: The differences in HR parameters identified by the meta-analysis indicate that ME/CFS patients have altered autonomic cardiac regulation when compared to healthy controls. These alterations in HR parameters may be symptomatic of the condition. SN - 1536-5964 UR - https://www.unboundmedicine.com/medline/citation/31651868/Evidence_of_altered_cardiac_autonomic_regulation_in_myalgic_encephalomyelitis/chronic_fatigue_syndrome:_A_systematic_review_and_meta_analysis_ L2 - https://doi.org/10.1097/MD.0000000000017600 DB - PRIME DP - Unbound Medicine ER -