Electrocardiographic QT interval and cardiovascular reactivity in fibromyalgia differ from chronic fatigue syndrome

Naschitz, Jochanan E.; Slobodin, Gleb; Sharif, Dauod; Fields, Madeline; Isseroff, Hillel; Sabo, Edmond; Rosner, Itzhak

doi:10.1016/j.ejim.2007.08.003

« Previous Next »European Journal of Internal Medicine
Volume 19, Issue 3 , Pages 187-191, May 2008

Electrocardiographic QT interval and cardiovascular reactivity in fibromyalgia differ from chronic fatigue syndrome

Jochanan E. Naschitz
- Departments of Internal Medicine A, Bnai Zion Medical Center and ‘Rappaport Family’ Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Corresponding author. Department of Internal Medicine A, Bnai Zion Medical Center, Haifa 31048, P.O. Box 4940, Israel.
Gleb Slobodin
- Departments of Internal Medicine A, Bnai Zion Medical Center and ‘Rappaport Family’ Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Dauod Sharif
- Heart Institute, Bnai Zion Medical Center and ‘Rappaport Family’ Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Madeline Fields
- Departments of Internal Medicine A, Bnai Zion Medical Center and ‘Rappaport Family’ Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Hillel Isseroff
- Departments of Internal Medicine A, Bnai Zion Medical Center and ‘Rappaport Family’ Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Edmond Sabo
- Departments of Internal Medicine A, Bnai Zion Medical Center and ‘Rappaport Family’ Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
Itzhak Rosner
- Rheumatology, Bnai Zion Medical Center and ‘Rappaport Family’ Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Received 17 February 2007; received in revised form 27 August 2007; accepted 30 August 2007. published online 15 November 2007.

Abstract

Background

Fibromyalgia (FM) and chronic fatigue syndrome (CFS) frequently overlap clinically and have been considered variants of one common disorder. We have recently shown that CFS is associated with a short corrected electrocardiographic QT interval (QTc). In the present study, we evaluated whether FM and CFS can be distinguished by QTc.

Methods

The study groups were comprised of women with FM (n=30) and with CFS (n=28). The patients were evaluated with a 10 min supine–30 min head-up tilt test. The electrocardiographic QT interval was corrected for heart rate (HR) according to Fridericia's equation (QTc). In addition, cardiovascular reactivity was assessed based on blood pressure and HR changes and was expressed as the ‘hemodynamic instability score’ (HIS).

Results

The average supine QTc in FM was 417 ms (SD 25) versus 372 ms (SD 22) in CFS (p<0.0001); the supine QTc cut-off <385.7 ms was 79% sensitive and 87% specific for CFS vs. FM. The average QTc at the 10th minute of tilt was 409 ms (SD 18) in FM versus 367 ms (SD 21) in CFS (p<0.0001); the tilt QTc cut-off <383.3 ms was 71% sensitive and 91% specific for CFS vs. FM. The average HIS in FM patients was −3.52 (SD 1.96) versus +3.21 (SD 2.43) in CFS (p<0.0001).

Conclusion

A relatively short QTc and positive HIS characterize CFS patients and distinguish them from FM patients. These data may support the contention that FM and CFS are separate disorders.

Keywords: Fibromyalgia, Chronic fatigue syndrome, Electrocardiography, QT interval, Cardiovascular reactivity, Fractal analysis