Abnormal changes during Tilt Table Test in ME/CFS patients are NOT related to deconditioning

Lisa108

Senior Member (Voting Rights)
This study was posted today on the German 'ME -Pacing mit Pulsuhr'-Facebook page:

The Abnormal Cardiac Index and Stroke Volume Index Changes During a Normal Tilt Table Test in ME/CFS Patients Compared to Healthy Volunteers, are Not Related to Deconditioning

C.(Linda) M.C. van Campen,Frans C. Visser*

Department of Cardiology,Stichting Cardiozorg, Planetenweg, Netherlands

Free access link here, just click through the buttons 'Abstract', 'Article', 'Figures', 'Tables', 'References', and 'Suggested Citation'.

It seems as if this will be published in the 'Journal of Thrombosis and Circulation'.
 
1. Abstract:

1.1 Background.
A small study in ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome) patients undergoing tilt testing, showed that, despite a normal tilt test, stroke volumes and cardiac output were lower than in healthy volunteers. Moreover, it was suggested that this difference was related to deconditioning of patients. Aim of the study. We performed table testing in 150 ME/CFS patients. Stroke volumes and cardiac output were related to the severity of the disease.

1.2 Methods and results.
In the patients the severity of the disease was clinically evaluated according to the ME criteria and scored as mild, moderate or severe disease. In a subgroup of 109 patients this clinical diagnosis was confirmed by the physical functioning score of the Rand-36 questionnaire. Significantly lower physical functioning scores (indicating worse functioning) were observed in the more severely affected patients. Stroke Volume Index (SVI) and Cardiac Index (CI) were measured by suprasternal aortic Doppler imaging in the supine position, prior to the tilt, and twice during the tilt. Thirty-seven healthy volunteers underwent the same tilt protocol. In all patients and all healthy volunteers, a normal heart rate and blood pressure response was observed during the tilt. The decreases in SVI and CI during the tilt was significantly larger in patients compared to the SVI and CI decrease in HV. The decrease in SVI and CI were similar and not significantly different between the mild, moderate, and severe ME groups.

1.3 Conclusions.
During a normal tilt table test decreases in SVI and CI decrease are significantly greater in ME/CFS patients than in HV, consistent with previous work. The absence of differences between patients with mild, moderate, and severe ME/CFS suggests that the decreases in stroke volumes and cardiac output are not related to deconditioning. Other factors like decreased blood volumes and autonomic dysfunction may cause this difference in the hemodynamic response between ME/CFS patients and HV.
 
Merged thread

MEA Summary Review: Cardiac abnormalities in ME/CFS not due to deconditioning | 26 November 2018

by Charlotte Stephens, Research Correspondent, ME Association. Nov. 2018.

https://www.meassociation.org.uk/20...s-not-due-to-deconditioning-26-november-2018/

Introduction

Linda van Campen and Frans Visser from the Netherlands have just published a study that examined stroke volume and cardiac output in ME/CFS. It confirmed earlier findings from a smaller study that changes occurred in these two key cardiac measures despite normal tilt-table results (Timmers et al., 2002).

Both studies found reduced cardiac output and stroke volumes during a tilt table test in ME/CFS patients compared to healthy controls. However, these patients had normal tilt table results, meaning their heart rate and blood pressure did not change significantly enough to be diagnosed with orthostatic intolerance.
 
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Conclusion

The results of this study confirm previous findings by Timmers et al. (2002) that ME/CFS patients who have a normal heart rate and blood pressure response to tilt testing have significantly lower stroke volume and cardiac output compared to healthy controls.

Furthermore, no differences in results were found between different disease severities, suggesting the findings are not due to deconditioning.

However, grouping to illness severities was not optimised, and there was a small control group which was not sedentary. So, while this study was large – which is welcomed – it could have been better. It would be worth repeating the research with better recruitment, and an improved cohort (a greater number of severely affected patients and sedentary controls).

The authors said:

“During a head-up tilt with a normal Heart Rate and Blood Pressure response, Stroke Volumes and Cardiac Output in ME/CFS patients decrease significantly more than in healthy volunteers.”

“The absence of a difference in the decreases of stroke volume and cardiac output between patients with mild, moderate, and severe disease suggests that the decrease of stroke volumes and cardiac output is not related to deconditioning.”

This study may also add weight to suspected dysregulated autonomic nervous system involvement in ME/CFS pathology.

Further study is needed to address the extent to which the cardiac and blood volume alterations in ME/CFS have physiological and clinical significance.

taken from the MEA review
 
I like the way this disputes earlier research findings, that interpreted lower heart stroke volumes and output as being due to deconditoning, thereby feeding the whole "unhelpful illness beliefs" BPS pantomime. If they are right in saying "The decrease in SVI and CI were similar and not significantly different between the mild, moderate, and severe ME groups", and that there would be significant differences if deconditiong was the cause ... then that is another nail in the coffin of the PACE hypothesis presumably, and all it implies.
 
Is this the only paper indicating that OI in ME isn't due to deconditioning that has come out within the past year? I seem to remember something else but might be mistaken.

@Trish - tagging you because I think you keep up with all this! :)
 
Is this the only paper indicating that OI in ME isn't due to deconditioning that has come out within the past year? I seem to remember something else but might be mistaken.

@Trish - tagging you because I think you keep up with all this! :)

Sorry, I don't remember. I tried a search but didn't find one.
 
“Stroke volumes and cardiac output were related to the severity of the disease.”

“The absence of differences between patients with mild, moderate, and severe ME/CFS suggests...”

Sorry haven’t read the paper yet, but, don’t these 2 statements contradict each other? What am I missing?
 
“Stroke volumes and cardiac output were related to the severity of the disease.”

“The absence of differences between patients with mild, moderate, and severe ME/CFS suggests...”

Sorry haven’t read the paper yet, but, don’t these 2 statements contradict each other? What am I missing?
Maybe they mean that the CI and SVI contribute to disability in ME, but don't track with the different severity types. So they make the disease severe, but they don't vary if the disease is more severe. If so, it's very poor wording on their choice.
 
“Stroke volumes and cardiac output were related to the severity of the disease.”

“The absence of differences between patients with mild, moderate, and severe ME/CFS suggests...”

Sorry haven’t read the paper yet, but, don’t these 2 statements contradict each other? What am I missing?

I think I may have found the answer to your question. I think the first statement refers to an action (seeing how these factors relate to one another), and the second to the outcome.

The last paragraph of section 4 explains how they went about things, which I can link to the first of your sentences which is part of the 'background' section:

"Moreover, it has been suggested that the larger cardiac output and stroke volume decrease in ME/CFS patients compared to HV was due to deconditioning [9]. As disease severity is inversely related physical functioning [28], the disease severity was correlated with the stroke volume and cardiac output changes." - correlated is an action too in this case.

With more severe patients being less active, you'd expect a bigger change in these measures if they are 'due to deconditioning', but this wasn't the case. Hence the conclusion.
 
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