Compression stockings improve cardiac output and cerebral blood flow during tilt testing in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) patients: a randomized crossover trial by  C. (Linda) M C van Campen, Peter C Rowe and Frans C Visser in Medicina 2022 58:1 [10.3390/medicina58010051] (This article belongs to the Special Issue Chronic Fatigue Syndrome: From Clinical Observations to Unifying Hypotheses of Disease Mechanisms)


Research abstract

Background and Objectives:

Orthostatic intolerance (OI) is a clinical condition in which symptoms worsen upon assuming and maintaining upright posture and are ameliorated by recumbency. OI has a high prevalence in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Limited data are available to guide the treatment of OI in ME/CFS patients. We and others have previously described patient-reported subjective improvement in symptoms using compression stockings. We hypothesized that these subjective reports would be accompanied by objective hemodynamic improvements.

Materials and Methods:

We performed a randomized crossover trial in 16 ME/CFS patients. Each underwent two 15-min head-up tilt table tests, one with and one without wearing knee-high compression stockings that provided 20–25 mm Hg compression. The order of the tests was randomized. We measured heart rate and blood pressure as well as cardiac output and cerebral blood flow (CBF) using extracranial Doppler of the internal carotid and vertebral arteries.


There were no differences in supine measurements between the 2 baseline measurements. There were no differences in heart rate and blood pressure at either end-tilt testing period. Compared to the test with the stockings off, the mean percentage reduction in cardiac output during the test with compression stockings on was lower, 15 (4)% versus 27 (6)% (p < 0.0001), as was the mean percentage CBF reduction, 14 (4)% versus 25 (5)% (p < 0.0001).


In ME/CFS patients with orthostatic intolerance symptoms, cardiac output and CBF are significantly reduced during a tilt test. These abnormalities were present without demonstrable heart rate and blood pressure changes and were ameliorated by the use of compression stockings.

Comment from full paper:

…using a questionnaire in our previous study on compression stockings, the positive and negative responses of wearing compression stockings to a variety of physical activities was variable and dependent on the degree of physical activity in question. In contrast, in the present study we found a uniform hemodynamic improvement when patients wore the stockings. Future work will be able to address whether specific symptoms such as exercise intolerance, pain, cognitive symptoms, lightheadedness or co-morbid disease will be more likely to improve with compression stockings.

This new finding supports the use of the compression stockings in these patients. Compression stockings may also be beneficial in non-ME/CFS populations with orthostatic intolerance.

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