Insights From Invasive Cardiopulmonary Exercise Testing of Patients With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

摘要: Background Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) affects tens of millions worldwide; the causes exertional intolerance are poorly understood. The ME/CFS label overlaps with postural orthostatic tachycardia (POTS) and fibromyalgia, objective evidence small fiber neuropathy (SFN) is reported in approximately 50% of POTS fibromyalgia patients. Research Question Can invasive cardiopulmonary exercise testing (iCPET) PGP9.5-immunolabeled lower-leg skin biopsies inform pathophysiology potential relationships SFN? Study Design Methods We analyzed 1,516 upright iCPETs performed to investigate intolerance. After excluding patients intrinsic heart or lung disease selecting those right atrial pressures (RAP)  Results During exercise, 160 averaged lower RAP (1.9 ± 2 vs 8.3 1.5; P  Interpretation These results identify two types peripheral neurovascular dysregulation that biologically plausible contributors intolerance—depressed Qc from impaired venous return, oxygen extraction. In small-fiber pathology, neuropathic causing microvascular dilation may limit exertion by shunting oxygenated blood capillary beds reducing cardiac return.