Journal of Thrombosis and Circulation (ISSN: 2690-0157)

research article

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 

*Corresponding author: Frans C Visser, Department of Cardiology, Stichting Cardiozorg, Planetenweg 5, 2132 HN Hoofddorp, Netherlands. Tel: +31-206597888; Fax: +31-205241235; Email: 

Received Date: 23 October, 2018; Accepted Date: 30 October, 2018; Published Date: 7 November, 2018

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. 

2.       Keywords: Cardiac Output; Chronic Fatigue Syndrome; Deconditioning; Head-Up Tilt Test; Myalgic Encephalomyelitis; ME Severity; Rand-36 Questionnaire; Stroke Volume 

3.       Abbreviations 

BMI                       :               Body Mass Index

BSA                        :               Body Surface Area

CFS                        :               Chronic Fatigue Syndrome

CI                           :               Cardiac Index

DBP                        :               Diastolic Blood Pressure

HR                          :               Heart Rate

HUT                       :               Head-Up Tilt Test

HV                          :               Healthy Volunteers

IOM                       :               Institute of Medicine

MAP                       :               Mean Blood Pressure

ME                         :               Myalgic Encephalomyelitis

NMH                      :               Neurally Mediated Hypotension

Normal BPHR      :               normal Blood Pressure and Heart Rate Response During HUT

OI                           :               Orthostatic Intolerance

R36 Phys Funct   :               Rand-36 Physical Functioning Score

SBP                        :               Systolic Blood Pressure

SVI                         :               Stroke Volume Index

SVRI                      :               Systemic Vascular Resistance Index

VTI                         :               Time-Velocity Integral