Trial Report Worsening Symptoms Is Associated with Larger Cerebral Blood Flow Abnormalities during Tilt-Testing in ME/CFS, 2023, van Campen

https://www.mdpi.com/1648-9144/59/12/2153

Worsening Symptoms Is Associated with Larger Cerebral Blood Flow Abnormalities during Tilt-Testing in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
by
C. (Linda) M. C. van Campen
1,*,
Peter C. Rowe
2 and
Frans C. Visser
1


1 Stichting CardioZorg, Planetenweg 5, 2132 HN Hoofddorp, The Netherlands
2 Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
*Author to whom correspondence should be addressed.
Medicina 2023, 59(12), 2153; https://doi.org/10.3390/medicina59122153
Submission received: 19 November 2023 / Revised: 6 December 2023 / Accepted: 11 December 2023 / Published: 12 December 2023

Abstract

Background and Objectives:

During tilt testing, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) patients experience an abnormal reduction in cerebral blood flow (CBF).

The relationship between this CBF reduction and symptom severity has not been examined in detail.

Our hypothesis was that ME/CFS severity is related to the degree of the CBF reduction during tilt testing.

Materials and Methods:

First, from our database, we selected ME/CFS patients who had undergone assessments of ME/CFS symptomatology and tilt tests on the same day, one at the first visit and the second during a follow-up.

The change in symptomatology was related to the change in CBF during the tilt test.

Second, we combined the data of two previously published studies (n = 219), where disease severity as defined by the 2011 international consensus criteria (ICC) was available but not published.

Results:

71 patients were retested because of worsening symptoms.

The ICC disease severity distribution (mild-moderate-severe) changed from 51/45/4% at visit-1 to 1/72/27% at follow-up (p < 0.0001).

The %CBF reduction changed from initially 19% to 31% at follow-up (p < 0.0001). Of 39 patients with stable disease, the severity distribution was similar at visit-1 (36/51/13%) and at follow-up (33/49/18%), p = ns.

The %CBF reduction remained unchanged: both 24%, p = ns. The combined data of the two previously published studies showed that patients with mild, moderate, and severe disease had %CBF reductions of 25, 29, and 33%, respectively (p < 0.0001).

Conclusions:

Disease severity and %CBF reduction during tilt testing are highly associated in ME/CFS: a more severe disease is related to a larger %CBF reduction.

The data suggest a causal relationship where a larger CBF reduction leads to worsening symptoms.


Keywords:
orthostatic intolerance; tilt-table testing; ME/CFS; stroke volume index; cardiac index; cerebral blood flow; disease severity; symptom worsening