Cerebral blood flow is reduced in severe myalgic encephalomyelitis/chronic fatigue syndrome patients during mild orthostatic stress testing: An exploratory study at 20 degrees of head-up tilt testing

C. Linda M.C. van Campen, Peter C. Rowe, Frans C. Visser

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: In a study of 429 adults with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), we demonstrated that 86% had symptoms of orthostatic intolerance in daily life. Using extracranial Doppler measurements of the internal carotid and vertebral arteries during a 30-min head-up tilt to 70 degrees, 90% had an abnormal reduction in cerebral blood flow (CBF). A standard head-up tilt test of this duration might not be tolerated by the most severely affected bed-ridden ME/CFS patients. This study examined whether a shorter 15-min test at a lower 20 degree tilt angle would be sufficient to provoke reductions in cerebral blood flow in severe ME/CFS patients. Methods and results: Nineteen severe ME/CFS patients with orthostatic intolerance complaints in daily life were studied: 18 females. The mean (SD) age was 35(14) years, body surface area (BSA) was 1.8(0.2) m2 and BMI was 24.0(5.4) kg/m2 . The median disease duration was 14 (IQR 5–18) years. Heart rate increased, and stroke volume index and end-tidal CO2 decreased significantly during the test (p ranging from <0.001 to <0.0001). The cardiac index decreased by 26(7)%: p < 0.0001. CBF decreased from 617(72) to 452(63) mL/min, a 27(5)% decline. All 19 severely affected ME/CFS patients met the criteria for an abnormal CBF reduction. Conclusions: Using a less demanding 20 degree tilt test for 15 min in severe ME/CFS patients resulted in a mean CBF decline of 27%. This is comparable to the mean 26% decline previously noted in less severely affected patients studied during a 30-min 70 degree head-up tilt. These observations have implications for the evaluation and treatment of severely affected individuals with ME/CFS.

Original languageEnglish (US)
Article number169
JournalHealthcare (Switzerland)
Volume8
Issue number2
DOIs
StatePublished - 2020

Keywords

  • 20 degree tilt table testing
  • Cardiac index
  • Cerebral blood flow
  • Chronic fatigue syndrome
  • Myalgic encephalomyelitis
  • Orthostatic intolerance
  • Postural orthostatic tachycardia syndrome
  • Stroke volume index

ASJC Scopus subject areas

  • Health Informatics
  • Health Policy
  • Health Information Management
  • Leadership and Management

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