Solve ME/CFS Initiative: Discovery Forum 2017: Presentation of Dr. Maureen Hanson

Dr. Hanson @ 3:33 [bolding mine]
[CPET] measures the maximum heart rate, oxygen consumption, ventilatory threshold, maximum workload and the respiratory exchange ratio. And this is very important and it's why people seek the test as an objective measure.

Because, if you have a respiratory exchange ratio of greater than 1.1, that really indicates the participants are performing that work at maximal level. They're not deliberately sloughing off and pretending that they can't exercise. They are doing their maximum effort.

So individuals who don't exercise regularly, who have heart failure, lung disease, multiple sclerosis or end-stage renal disease, are known to reproduce their CPET... within about 7% twenty-four hours later, or later than that, but most CFS patients exhibit altered performance 24 hours after their first maximal CPET.

I'm just going to show one example of a patient who came in with a VO2 max of 25, anaerobic threshold of 16.

This is... you know, a sedentary person might have that level of VO2 max... but, when they came in for the second test, their VO2 max and their anaerobic threshold went down 25% and 27% and that's something that hasn't been seen in other illnesses and is really a hallmark objective factor that you can use to diagnose the disease, but it also shows that somebody with this reduced VO2 max is really disabled.
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Perhaps it's time to declare that there is a biomarker.
 
Forbin said:
Perhaps it's time to declare that there is a biomarker.
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There does seem to be increasing evidence that would support two-day CPET as demonstrating a difference in ME/CFS patients to healthy controls. I'm not sure we're quite at the stage of saying it's a useful biomarker - we would need more data to replicate what has been discussed so far, plus wider testing of health conditions to demonstrate the second day drop-off as being truly unique to ME/CFS (though I believe some has already been done). And, as @adambeyoncelowe notes above, it's not a great biomarker if the test itself can make the patient (permanently?) worse: it's a bit like testing for a potential aneurysm by giving the patient drugs to raise their blood pressure to see if it bursts... 'Yep, we've confirmed the aneurysm. Sadly the patient died, but at least we've got a result!'. OTOH, it does at least provide objective evidence against the Tinkerbell view of ME/CFS.
 
This presentation is very similar to the one she made at the OMF symposium last year, in fact i bet its the same presentation with some updates

Londinium said:
And, as @adambeyoncelowe notes above, it's not a great biomarker if the test itself can make the patient (permanently?) worse: it's a bit like testing for a potential aneurysm by giving the patient drugs to raise their blood pressure to see if it bursts... 'Yep, we've confirmed the aneurysm. Sadly the patient died, but at least we've got a result!'
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I have to admit this made me laugh :emoji_smile:
 
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