Usefulness of an abnormal cardiovascular response during low-grade head-up tilt-test for ... adolescents with chronic fatigue ..., 2007, Wyller et al

Discussion in 'ME/CFS research' started by Hutan, Jun 1, 2023.

  1. Hutan

    Hutan Moderator Staff Member

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    Usefulness of an abnormal cardiovascular response during low-grade head-up tilt-test for discriminating adolescents with chronic fatigue from healthy controls
    Vegard Bruun Wyller 1, Reidar Due, J Philip Saul, Jan P Amlie, Erik Thaulow
    2007

    https://pubmed.ncbi.nlm.nih.gov/17398200/

    Hemodynamic dysfunction is documented in chronic fatigue syndrome (CFS). This study was conducted to investigate cardiovascular responses to orthostatic stress in adolescents with CFS, using a novel procedure for tilt-table testing. A total of 27 adolescents with CFS and 33 healthy control subjects with equal age and gender distribution underwent 15 minutes of 20 degrees head-up tilt testing. Heart rate, systolic blood pressure (BP), mean BP, diastolic BP, stroke index, total peripheral resistance index, end-diastolic volume index, and acceleration index were continuously and noninvasively recorded.

    At rest, patients with CFS had higher total peripheral resistance index values (p<0.01) and lower stroke index and end-diastolic volume index values (p<0.05) than controls. During 20 degrees head-up tilt testing, patients with CFS had greater increases in heart rate, diastolic BP (p<0.001), mean BP (p<0.01), and total peripheral resistance index (p<0.05) than controls and greater decreases in stroke index (p<0.05). Syncope or near syncope was not observed. In conclusion, this study found that adolescents with CFS have significant abnormalities of cardiovascular regulation in response to mild orthostatic stress, differentiating them from healthy controls.
     
    Last edited: Jun 1, 2023
  2. Hutan

    Hutan Moderator Staff Member

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    From 2007, in case you missed that. And I think that's the BPS Wyller.

    To repeat the conclusion:
    this study found that adolescents with CFS have significant abnormalities of cardiovascular regulation in response to mild orthostatic stress, differentiating them from healthy controls.

    Here is an objective measure, known about for years, why has it not been included as an outcome in treatment trials?

    20 degrees is hardly any degree of tilt - so the laughable 'fear of standing' idea that has been proposed to explain OI in ME/CFS doesn't apply.
     
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  3. Amw66

    Amw66 Senior Member (Voting Rights)

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    Sadly this info has so little effect in peadiatrics .
    Even now it's rarely on the radar .
     
  4. dave30th

    dave30th Senior Member (Voting Rights)

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    it is. how interesting.
     
  5. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Just looking at the abstract posted I am not sure this shows anything. I think it might simply indicate an adrenaline surge in patients.

    If you put patients and healthy people in a strange contraption supposedly to 'test' for signs of illness you are likely to get different adrenaline output in people who understand that they are ill and people who see themselves as well and just there as 'controls'.

    Fifteen minutes of 20 degree tilt seems to me to be hard to interpret. The effect on physiology may have more to do with being immobilised in one position than anything to do with tilt. There may be a lot more in the paper.

    The conclusion from Wyller might well be that PWME are more easily stressed but do not actually pass out. But they will be more stressed simply because the situation is more stressful than for controls.
     
  6. Trish

    Trish Moderator Staff Member

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    Could that problem of an adrenaline surge in the patient's be overcome using several different angles for a few minutes each and looking for a dose response? If it's purely stress based adrenaline surge causing the cardiovascular signs, then the response should be the same regardless of angle of tilt.
    And change the order - start them at, say 10%, then make the tilt go to horizontal as though that were the test.
     
  7. Hutan

    Hutan Moderator Staff Member

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    If you click on the Wyller link, you will see that he did a whole lot of investigations in young people with CFS. It could be interesting to pick through them - maybe there are some clues as to where he started and how he got to where he is now, with respect to ME/CFS. Maybe our Norwegian members have some insights.

    I thought this other paper in particular was worth a look.

    Elevated nocturnal blood pressure and heart rate in adolescent chronic fatigue syndrome

    Harald Hurum 1, Dag Sulheim, Erik Thaulow, Vegard Bruun Wyller
    2011

    Aim: To compare ambulatory recordings of heart rate (HR) and blood pressure in adolescents with chronic fatigue syndrome (CFS) and healthy controls. We hypothesized both HR and blood pressure to be elevated among CFS patients.

    Methods: Forty-four CFS patients aged 12-18 years were recruited from our paediatric outpatient clinic. The controls were 52 healthy adolescents having similar distribution of age and gender. 24-h ambulatory blood pressure and HR were recorded using a validated, portable oscillometric device.

    Results: At night (sleep), HR, mean arterial blood pressure and diastolic blood pressure were significantly higher in CFS patients as compared with controls (p < 0.01). During daytime, HR was significantly higher among CFS patients (p < 0.05), whereas blood pressures were equal among the two groups.

    Conclusions: The findings support previous experimental evidence of sympathetic predominance of cardiovascular control in adolescent CFS patients. Also, the findings prompt increased focus on cardiovascular risk assessment and suggest a possible target for therapeutic intervention.
     
  8. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

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    Screenshot 2023-06-01 at 9.16.39 PM.jpg

    From the discussion —

     
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  9. ME/CFS Skeptic

    ME/CFS Skeptic Senior Member (Voting Rights)

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    It look like these were just greater increases in heart rate and blood pressure in the ME/CFS group compared to healthy controls. Perhaps it could be the result of deconditioning/being less fit?
     
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  10. Hutan

    Hutan Moderator Staff Member

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