{"id":26575,"date":"2020-06-17T06:24:13","date_gmt":"2020-06-17T06:24:13","guid":{"rendered":"https:\/\/wames.org.uk\/cms-english\/?p=26575"},"modified":"2020-09-03T09:34:33","modified_gmt":"2020-09-03T09:34:33","slug":"cerebral-blood-flow-is-reduced-in-severe-me-cfs-patients-during-mild-orthostatic-stress-testing-an-exploratory-study-at-20-degrees-of-head-up-tilt-testing","status":"publish","type":"post","link":"https:\/\/wames.org.uk\/cms-english\/cerebral-blood-flow-is-reduced-in-severe-me-cfs-patients-during-mild-orthostatic-stress-testing-an-exploratory-study-at-20-degrees-of-head-up-tilt-testing\/","title":{"rendered":"Cerebral blood flow is reduced in severe ME\/CFS patients during mild orthostatic stress testing: an exploratory study at 20 degrees of head-up tilt testing"},"content":{"rendered":"

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<\/a>, by C (Linda) MC van Campen, Peter C Rowe\u00a0\u00a0and Frans C Visser in Healthcare 2020, 8(2), 169, 13 June 2020 [doi.org\/10.3390\/healthcare8020169]\u00a0 (This article belongs to the Special Issue\u00a0ME\/CFS \u2013 the Severely and Very Severely Affected)<\/h3>\n

 <\/p>\n

Research abstract:<\/strong><\/h3>\n

Introduction:<\/strong><\/p>\n

\"\" 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<\/a> to 70 degrees, 90% had an abnormal reduction in cerebral blood flow<\/a> (CBF).<\/p>\n

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.<\/p>\n

Methods and results:<\/strong><\/p>\n

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\u00a0and BMI was 24.0(5.4) kg\/m2. The median disease duration was 14 (IQR 5\u201318) years. Heart rate increased, and stroke volume index and end-tidal CO2\u00a0decreased significantly during the test (p\u00a0ranging from <0.001 to <0.0001). The cardiac index decreased by 26(7)%:\u00a0p\u00a0< 0.0001. CBF decreased from 617(72) to 452(63) mL\/min, a 27(5)% decline.<\/p>\n

All 19 severely affected ME\/CFS patients met the criteria for an abnormal CBF reduction.<\/p>\n

Conclusions: <\/strong><\/p>\n

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.<\/p>\n

These observations have implications for the evaluation and treatment of severely affected individuals with ME\/CFS.<\/p>\n

4.1. Clinical Implications<\/strong><\/p>\n

Patients are advised to lie down when they experience orthostatic intolerance complaints. Our findings of a clinically significant cerebral blood flow reduction at just 20 degrees suggest that a slight head-up position may not be adequate enough to resolve symptoms of orthostatic intolerance in some patients. Furthermore, the European Society of Cardiology syncope guidelines and other papers advocate the use of a nocturnal head-up position of more than 10 degrees to prevent nocturnal polyuria and the consequent circulatory underfilling [45,46,47,48]. In light of the presented results, this advice has the potential to be detrimental in some ME\/CFS patients.<\/p>\n

Health rising<\/strong>: Low Brain Blood Flows and Orthostatic Intolerance Ubiquitous in Chronic Fatigue Syndrome (ME\/CFS)<\/a>, by Cort Johnson<\/p>\n","protected":false},"excerpt":{"rendered":"

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, by C (Linda) MC van Campen, Peter C Rowe\u00a0\u00a0and Frans C Visser in … Continue reading →<\/span><\/a><\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[1],"tags":[5961,5425,5962,798,5424,5688,492,1023,332,5963],"class_list":["post-26575","post","type-post","status-publish","format-standard","hentry","category-news","tag-20-degree-tilt-table-testing","tag-c-linda-mc-van-campen","tag-cardiac-index","tag-cerebral-blood-flow","tag-frans-c-visser","tag-head-up-tilt-test","tag-orthostatic-intolerance","tag-peter-c-rowe","tag-postural-orthostatic-tachycardia-syndrome","tag-stroke-volume-index"],"jetpack_publicize_connections":[],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"jetpack_shortlink":"https:\/\/wp.me\/p5qkYK-6UD","_links":{"self":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/26575","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/comments?post=26575"}],"version-history":[{"count":4,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/26575\/revisions"}],"predecessor-version":[{"id":27881,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/posts\/26575\/revisions\/27881"}],"wp:attachment":[{"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/media?parent=26575"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/categories?post=26575"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wames.org.uk\/cms-english\/wp-json\/wp\/v2\/tags?post=26575"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}