Compression Stockings Improve Cardiac Output and Cerebral Blood Flow during Tilt Testing in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) Patients:  A Randomized Crossover Trial.

Abstract

Background and Objectives: Orthostatic intolerance (OI) is a clinical condition in which symptoms worsen upon assuming and maintaining upright posture and are  ameliorated by recumbency. OI has a high prevalence in patients with myalgic  encephalomyelitis/chronic fatigue syndrome (ME/CFS). Limited data are available  to guide the treatment of OI in ME/CFS patients. We and others have previously  described patient-reported subjective improvement in symptoms using compression  stockings. We hypothesized that these subjective reports would be accompanied by  objective hemodynamic improvements. Materials and Methods: We performed a  randomized crossover trial in 16 ME/CFS patients. Each underwent two 15-min  head-up tilt table tests, one with and one without wearing knee-high compression  stockings that provided 20-25 mm Hg compression. The order of the tests was  randomized. We measured heart rate and blood pressure as well as cardiac output  and cerebral blood flow (CBF) using extracranial Doppler of the internal carotid  and vertebral arteries. Results: There were no differences in supine measurements  between the 2 baseline measurements. There were no differences in heart rate and  blood pressure at either end-tilt testing period. Compared to the test with the  stockings off, the mean percentage reduction in cardiac output during the test  with compression stockings on was lower, 15 (4)% versus 27 (6)% (p < 0.0001), as  was the mean percentage CBF reduction, 14 (4)% versus 25 (5)% (p < 0.0001).  Conclusion: In ME/CFS patients with orthostatic intolerance symptoms, cardiac  output and CBF are significantly reduced during a tilt test. These abnormalities  were present without demonstrable heart rate and blood pressure changes and were  ameliorated by the use of compression stockings.