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Ryabkova VA, Rubinskiy AV, Marchenko VN, Trofimov VI, Churilov LP. Similar Patterns of Dysautonomia in Myalgic Encephalomyelitis/Chronic Fatigue and Post-COVID-19 Syndromes. PATHOPHYSIOLOGY 2024; 31:1-17. [PMID: 38251045 PMCID: PMC10801610 DOI: 10.3390/pathophysiology31010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/26/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND There is a considerable overlap between the clinical presentation of post-COVID-19 condition (PCC) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Many of their common symptoms can be linked to dysregulation of the autonomic nervous system (dysautonomia). This study aimed to objectively assess autonomic function in a general group of patients with PCC and in a group of patients with ME/CFS whose disease was not related to COVID-19. We hypothesize that the similarity in the chronic symptoms of patients with PCC and ME/CFS extends to objective autonomic nervous system abnormalities. METHODS Synchronous recordings of an electrocardiogram and continuous dynamics of blood pressure in the digital artery using the Penaz method were obtained using the spiroarteriocardiorhythmography method in 34 patients diagnosed with ME/CFS, in whom the onset of the disease was not associated with COVID-19, 29 patients meeting the PCC definition and 32 healthy controls. Heart rate variability (HRV) and systolic and diastolic blood pressure variability (BPV) were assessed at rest and in tests with fixed respiratory rates. Indicators of baroreflex regulation (baroreflex effectiveness index and baroreflex sensitivity) were additionally determined at rest. RESULTS The total power and power of low-frequency and high-frequency of RR interval variability at rest as well as baroreflex sensitivity were significantly lower both in PCC and ME/CFS patients compared to healthy controls. Several diagnostic prediction models for ME/CFS were developed based on HRV parameters. During slow breathing, the HRV parameters returned to normal in PCC but not in ME/CFS patients. The correlation analysis revealed a close relationship of HRV, BPV parameters and baroreflex sensitivity with fatigue, but not with HADS depressive/anxiety symptoms in the ME/CFS and PCC patients. CONCLUSIONS A similar pattern of HRV and baroreflex failure with signs of a pathological acceleration of age-dependent dysautonomia was identified in the ME/CFS and PCC patients. The clinical, diagnostic and therapeutic implications of these findings are discussed, in light of previously described relationships between inflammation, vascular pathology, atherosclerotic cardiovascular disease and autonomic dysfunction.
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Affiliation(s)
- Varvara A. Ryabkova
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, 199034 Saint-Petersburg, Russia;
- Department of Pathology, Saint Petersburg State University, 199034 Saint-Petersburg, Russia
- Department of Hospital Therapy Named after Academician M.V. Chernorutskii, Research Institute of Rheumatology and Allergology, Pavlov First Saint Petersburg State Medical University, 197022 Saint-Petersburg, Russia; (V.N.M.); (V.I.T.)
| | - Artemiy V. Rubinskiy
- Department of Medical Rehabilitation and Adaptive Physical Culture, Pavlov First Saint Petersburg State Medical University, 197022 Saint-Petersburg, Russia;
| | - Valeriy N. Marchenko
- Department of Hospital Therapy Named after Academician M.V. Chernorutskii, Research Institute of Rheumatology and Allergology, Pavlov First Saint Petersburg State Medical University, 197022 Saint-Petersburg, Russia; (V.N.M.); (V.I.T.)
| | - Vasiliy I. Trofimov
- Department of Hospital Therapy Named after Academician M.V. Chernorutskii, Research Institute of Rheumatology and Allergology, Pavlov First Saint Petersburg State Medical University, 197022 Saint-Petersburg, Russia; (V.N.M.); (V.I.T.)
| | - Leonid P. Churilov
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, 199034 Saint-Petersburg, Russia;
- Department of Pathology, Saint Petersburg State University, 199034 Saint-Petersburg, Russia
- Laboratory of Microangiopathic Mechanisms of Atherogenesis, Saint Petersburg State University, 199034 Saint-Petersburg, Russia
- Saint Petersburg Research Institute of Phthisiopulmonology, 191036 Saint Petersburg, Russia
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Zambach C, Pan J, Gerward S, Fedorowski A, Smith JG, Engström G, Hamrefors V. The relationships between the plasma metabolome and orthostatic blood pressure responses. Sci Rep 2023; 13:18244. [PMID: 37880314 PMCID: PMC10600108 DOI: 10.1038/s41598-023-44226-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 10/05/2023] [Indexed: 10/27/2023] Open
Abstract
Whereas autonomic dysfunction and the metabolic syndrome are clinically associated, the relationships with the plasma metabolome is unknown. We explored the association between orthostatic blood pressure responses and 818 plasma metabolites in middle-aged subjects from the general population. We included 3803 out of 6251 subjects (mean age, 57 years; 52% women) from the Malmö sub-cohort of The Swedish CardioPulmonary bioImage Study with information on smoking habits, diabetes, antihypertensive drug treatment, anthropometrics, hemodynamic measurements and 818 plasma metabolites (mass-spectrometry). The associations between each metabolite and orthostatic systolic blood pressure responses were determined using multivariable linear regression analysis and p values were corrected using the Bonferroni method. Six amino acids, five vitamins, co-factors and carbohydrates, nine lipids and two xenobiotics were associated with orthostatic blood pressure after adjusting for age, gender and systolic blood pressure. After additional adjustments for BMI, diabetes, smoking and antihypertensive treatment, the association remained significant for six lipids, four amino acids and one xenobiotic. Twenty-two out of 818 plasma metabolites were associated with orthostatic blood pressure responses. Eleven metabolites, including lipids in the dihydrosphingomyelin and sphingosine pathways, were independently associated with orthostatic systolic blood pressure responses after additional adjustment for markers of cardio-metabolic disease.
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Affiliation(s)
- Christian Zambach
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20313, Malmö, Sweden.
- Department of Internal Medicine, Skåne University Hospital, Lund, Sweden.
| | - Jingxue Pan
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20313, Malmö, Sweden
- Division of Child Healthcare, Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sofia Gerward
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20313, Malmö, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20313, Malmö, Sweden
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University and Skåne University Hospital, Lund, Sweden
- Wallenberg Center for Molecular Medicine and Lund University Diabetes Center, Lund University, Lund, Sweden
- The Wallenberg Laboratory/Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20313, Malmö, Sweden
| | - Viktor Hamrefors
- Department of Clinical Sciences, Clinical Research Center, Lund University, Box 50332, 20313, Malmö, Sweden
- Department of Cardiology, Skåne University Hospital, Malmö, Sweden
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