The higher resting heart rate in ME/CFS patients compared to healthy controls: relation with stroke volume, 2022, van Campen & Visser

Introduction: In patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) a higher-than-normal resting heart rate has been reported in a number of studies. As heart rate is linked to stroke volume, the present study explored the relationship between the supine heart rate and stroke volume index in healthy controls and in ME/CFS patients. Moreover, as patients with a postural orthostatic tachycardia syndrome (POTS) during tilt testing, have a higher supine heart rate than patients with a normal heart rate and blood pressure response during tilting, these two patient groups were also compared.

Methods and results: From a database of individuals who had undergone tilt-testing, including supine Doppler measurements for stroke volume index calculation, we selected ME/CFS patients and healthy controls without evidence of hypotension or syncope. 474 ME/CFS patients were analyzed, 314 with a normal heart rate and blood pressure response and 160 with POTS during tilt-testing, and 56 healthy controls. Resting stroke volume indices were similar between the 3 groups. All 3 groups had an inverse relation between the resting stroke volume index and resting heart rate (all p<0.0001). The slope of the relation was not significantly different between the 3 groups. Using the upper limit of the 95% prediction interval for the heart rate of healthy controls, 46 (15%) of patients with a normal heart rate and blood pressure response had a resting heart rate above the upper limit, 248 (85%) a heart rate between the upper and lower limit. In 47 (29%) patients developing POTS the resting heart rate was above the upper limit, and in 113 (71%) patients within the upper limit and lower limit. This distribution was significantly different between the two patient groups (p=0.0001).

Conclusion: Patients and healthy controls showed a significant and inverse relation between the SVI and heart rate at rest. Already at rest heart rate in patients developing POTS during tilt-testing were higher compared to the patients with a normal heart rate and blood pressure response per unit of SVI, but the heart rate of the majority of all patients fell within the limits of normal of healthy controls. The difference of patients with heart rate above the upper limit versus between the upper limit and lower limit deserves further investigation and may have therapeutic implications.

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Yes. Also i was under the impression that in general, the fitter you are the lower your resting HR? If so then doesnt it stand to reason that unless the cohort was of only mild sufferers, the controls are likely to be fitter than the patients

 

When I had my TTT in 2018, my resting HR at home that morning was 69 bpm. At that time the range for my RHR varied between 60 to 100 bpm.

Although I'd managed to arrange a lift home, getting to the Hospital (which was about 30 miles away) took about two and half hours and three buses with some walking and hanging about between connections. I had about an hour to wait at the hospital before my appointment.

They do have you lying quietly for a while before taking the supine HR ( I can't remember how long). Even with that and the hour before in the waiting area trying to get as close to horizontal as I could in a hospital chair, my supine HR was somewhere in the 90s. My main concern was that as my HR was already 20-30 bpm above my morning rate before I'd even had an upright tilt, I wouldn't reach the threshhold when upright.

I think I remember Peter Rowe saying in a recent video, that he now compares the upright HR with a RHR taken after the Tilt during the supine recovery period.

Gradually over the last 4 years my RHR range has narrowed to mostly between 55 and 65 bpm. If it goes higher than 65 I'm either doing too much or my sleep.