Brain Imaging and Behavior

, Volume 13, Issue 3, pp 789–797 | Cite as

Cerebral blood flow and heart rate variability predict fatigue severity in patients with chronic fatigue syndrome

  • Jeff Boissoneault
  • Janelle Letzen
  • Michael Robinson
  • Roland StaudEmail author
Original Research


Prolonged, disabling fatigue is the hallmark of chronic fatigue syndrome (CFS). Previous neuroimaging studies have provided evidence for nervous system involvement in CFS etiology, including perturbations in brain structure/function. In this arterial spin labeling (ASL) MRI study, we examined variability in cerebral blood flow (CBFV) and heart rate (HRV) in 28 women: 14 with CFS and 14 healthy controls. We hypothesized that CBFV would be reduced in individuals with CFS compared to healthy controls, and that increased CBFV and HRV would be associated with lower levels of fatigue in affected individuals. Our results provided support for these hypotheses. Although no group differences in CBFV or HRV were detected, greater CBFV and more HRV power were both associated with lower fatigue symptom severity in individuals with CFS. Exploratory statistical analyses suggested that protective effects of high CBFV were greatest in individuals with low HRV. We also found novel evidence of bidirectional association between the very high frequency (VHF) band of HRV and CBFV. Taken together, the results of this study suggest that CBFV and HRV are potentially important measures of adaptive capacity in chronic illnesses like CFS. Future studies should address these measures as potential therapeutic targets to improve outcomes and reduce symptom severity in individuals with CFS.


Chronic fatigue Brain imaging Regional signal variability Heart rate variability Arterial spin labeling Cerebral blood flow 



This study was funded by NIH grant R01 NR014049 and NIH/NCATS Clinical and Translational Science grants UL1 TR000064.

Compliance with ethical standards

Conflict of interest

Author Jeff Boissoneault declares that he has no conflict of interest.

Author Janelle Letzen declares that she has no conflict of interest.

Author Michael Robinson declares that he has no conflict of interest.

Author Roland Staud declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Clinical and Health PsychologyUniversity of FloridaGainesvilleUSA
  2. 2.Department of Psychiatry and Behavioral SciencesJohns Hopkins UniversityBaltimoreUSA
  3. 3.Department of Medicine, College of MedicineUniversity of FloridaGainesvilleUSA

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