Key result
ME/CFS patients reported significantly more orthostatic intolerance symptoms during the 10-minute NASA Lean Test compared to healthy controls (55% vs 21%), with patients sick for less than 4 years exhibiting marked circulatory decompensation.
Why the study?
Orthostatic intolerance is common in ME/CFS, but the hemodynamic changes occurring during the 10-minute NASA Lean Test in these patients were not well understood.
Does the 10-minute NASA Lean Test identify hemodynamic changes indicative of orthostatic intolerance in ME/CFS patients?
Cross-Sectional (n=225)
No
Does the 10-minute NASA Lean Test identify hemodynamic changes indicative of orthostatic intolerance in ME/CFS patients?
Absolute Event Rate: 55% vs 21%
p-value: p=<0.0005
The 10-minute NASA Lean Test identifies circulatory decompensation characterized by increased heart rate and narrow pulse pressure in ME/CFS patients sick for <4 years, aiding in the early diagnosis and management of orthostatic intolerance.
May support early orthostatic screening in recent-onset ME/CFS; hypothesis-generating and requires prospective validation before practice change.
Background Lightheadedness, fatigue, weakness, heart palpitations, cognitive dysfunction, muscle pain, and exercise intolerance are some of the symptoms of orthostatic intolerance (OI). There is substantial comorbidity of OI in ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome). The 10-minute NASA Lean Test (NLT) is a simple, point-of-care method that can aid ME/CFS diagnosis and guide management and treatment of OI. The objective of this study was t o understand the hemodynamic changes that occur in ME/CFS patients during the 10-minute NLT. Methods A total of 150 ME/CFS patients and 75 age, gender and race matched healthy controls (HCs) were enrolled. We recruited 75 ME/CFS patients who had been sick for less than 4 years (<4 ME/CFS) and 75 ME/CFS patients sick for more than 10 years (>10 ME/CFS). The 10-minute NLT involves measurement of blood pressure and heart rate while resting supine and every minute for 10 minutes while standing with shoulder-blades on the wall for a relaxed stance. Spontaneously reported symptoms are recorded during the test. ANOVA and regression analysis were used to test for differences and relationships in hemodynamics, symptoms and upright activity between groups. Results At least 5 minutes of the 10-minute NLT were required to detect hemodynamic changes. The <4 ME/CFS group had significantly higher heart rate and abnormally narrowed pulse pressure compared to >10 ME/CFS and HCs. The <4 ME/CFS group experienced significantly more OI symptoms compared to >10 ME/CFS and HCs. The circulatory decompensation observed in the <4 ME/CFS group was not related to age or medication use. Conclusions Circulatory decompensation characterized by increased heart rate and abnormally narrow pulse pressure was identified in a subgroup of ME/CFS patients who have been sick for <4 years. This suggests inadequate ventricular filling from low venous pressure. The 10-minute NLT can be used to diagnose and treat the circulatory decompensation in this newly recognized subgroup of ME/CFS patients. The >10 ME/CFS group had less pronounced hemodynamic changes during the NLT possibly from adaptation and compensation that occurs over time. The 10-minute NLT is a simple and clinically useful point-of-care method that can be used for early diagnosis of ME/CFS and help guide OI treatment.
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Lee et al. (2020) conducted a cross-sectional in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) (n=225). Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) vs. Healthy controls was evaluated on Spontaneously reported orthostatic intolerance (OI) symptoms during the 10-minute NASA Lean Test (p=<0.0005). ME/CFS patients reported significantly more orthostatic intolerance symptoms during the 10-minute NASA Lean Test compared to healthy controls (55% vs 21%), with patients sick for less than 4 years exhibiting marked circulatory decompensation.
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