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

Jeff Boissoneault, Janelle Letzen, Michael Robinson, Roland Staud

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)789-797
Number of pages9
JournalBrain Imaging and Behavior
Issue number3
StatePublished - Jun 15 2019
Externally publishedYes

Bibliographical note

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

Publisher Copyright:
© 2018, Springer Science+Business Media, LLC, part of Springer Nature.


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


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