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Is Postural Orthostatic Tachycardia a Useful Diagnostic Marker in Chronic Fatigue Syndrome Patients?

JaimeS

Senior Member
Messages
3,408
Location
Silicon Valley, CA
M.E. Roerink, J.W.M Lenders, I.C. Schmits, A. Pistorius, H. Knoop, J.W.M. van der Meer

Researchers from Germany and the Netherlands

From http://www.jpsychores.com/article/S0022-3999(16)30280-X/abstract -- but you can see the whole (rather useless) article right there.

CDC Consensus Criteria (which is... what?) patients were compared with patients with chronic fatigue symptoms who did not meet this criteria.

....oh, it's the Fukuda criteria. So they compared Fukuda patients with patients with unexplained fatigue; and patients in both groups had similar (low!) incidence of POTS.

I'm not sure what the difference between these two groups would be in the first place! Fukuda isn't very specific.

Sorry to present you all with something so useless! It's really too bad, if they'd used the CCC or something more specific, I would have been very interested to see the results. They had large cohort numbers, too; it's a shame.

-J
 

Gijs

Senior Member
Messages
690
Fortunately there are no CBT/GET studies done with POTS, so there conclusion is very poor and useless. They really would like POTS patiënt follow CBT too so they can also ignore these symptoms, i guess. They are real Dutch quackers. CBT is a very dangerous religion.
 

Kati

Patient in training
Messages
5,497
@JaimeS do you mind copying and pasting the abstract when uou post a new publication? My ipad often tome canno open the links so i ca't see them. Thx.
 

Sushi

Moderation Resource Albuquerque
Messages
19,935
Location
Albuquerque
Fortunately there are no CBT/GET studies done with POTS
Unfortunately I remember one: astronauts who returned with POTS and were given a type of GET. I don't have the reference handy, but years ago they were trying to apply this therapy to ME/CFS patients with POTS.
 

JaimeS

Senior Member
Messages
3,408
Location
Silicon Valley, CA
@JaimeS do you mind copying and pasting the abstract when uou post a new publication? My ipad often tome canno open the links so i ca't see them. Thx.

I didn't cut-and-paste because the whole thing is a pdf. However, they did have the following in text:

Background: Recently it has been suggested that the postural orthostatic tachycardia syndrome (POTS) is an objective diagnostic marker in patients with chronic fatigue syndrome (CFS). In a large Dutch CFS cohort, the prevalence of POTS was compared to the prevalence of POTS in persistent fatigued patients who did not meet CDC consensus criteria for CFS. Second, it was assessed whether CFS patients with POTS are less physically active, more impaired or respond differently to treatment with cognitive behavior therapy (CBT) as compared to CFS patients without POTS.
 

mango

Senior Member
Messages
905
Background:

Recently it has been suggested that the postural orthostatic tachycardia syndrome (POTS) is an objective diagnostic marker in patients with chronic fatigue syndrome (CFS). In a large Dutch CFS cohort, the prevalence of POTS was compared to the prevalence of POTS in persistent fatigued patients who did not meet CDC consensus criteria for CFS.

Second, it was assessed whether CFS patients with POTS are less physically active, more impaired or respond differently to treatment with cognitive behavior therapy (CBT) as compared to CFS patients without POTS.

Method:

Between June 2013 and December 2014, all consecutively referred patients complaining of persistent fatigue underwent a standardized active standing test, with measurement of blood pressure and heart rate, as part of their initial evaluation.

All patients filled out web-based questionnaires and wore an activity sensing device for twelve consecutive days. POTS was defined as an increase in heart rate by ≥ 30 beats per minute within the first ten minutes after attaining the upright position, or as the standing heart rate exceeded 120 beats per minute.

Results:

419 patients were diagnosed with CFS and 341 patients complained about severe fatigue without CFS. POTS prevalence in the adult CFS population was 5.7%, which was not different from prevalence in non-CFS adults (6.9%, p = 0.54).

In adolescents, prevalence was 18.2% and 17.4% respectively (p = 0.93). Adult POTS-CFS patients were younger (30 ± 12 vs. 40 ± 13 years old, p = 0.001), and had a higher heart rate in supine position (71 ± 11 vs 65 ± 9 beats per minute, p = 0.009) compared to non-POTS CFS patients.

Between POTS and non-POTS CFS patients, there were no differences with respect to blood pressure, CFS-related symptoms, use of medication or physical activity patterns. POTS-CFS adolescents, but not adults, had decreased recovery rates after CBT (58.3% vs. 88.4%, p = 0.017).

Conclusion:

In adults with CFS, POTS prevalence was low, not different from the non-CFS fatigued population, and was not related to disease severity or treatment outcome. In adolescents, POTS-CFS patients recovered less frequently after CBT, but this difference was not large enough to withhold the intervention from these patients.

The evaluation of POTS seems of no significant additional value for the diagnosis of CFS.

http://www.jpsychores.com/article/S0022-3999(16)30280-X/abstract

@Kati
 

anciendaze

Senior Member
Messages
1,841
I'd point out that criteria for POTS are often a mess, so that the same patient can be placed in both the POTS cohort and the fatigued without POTS cohort by different investigators. We have even had a forum member with a heart rate of 150 told he did not have POTS because he just had a high heart rate. (His sitting rate was assumed to be basal because the doctor didn't feel that sitting presented any effort. )

Myself, I do not claim to have POTS, but do show neurally-mediated hypotension (NMH). Some doctors would amend this to neurally-mediated syncope (NMS) then tell me I don't have it because it takes me some 20 minutes to pass out. ("So it's normal for people like me to lie down if forced to stand for 20 minutes? Could you tell the manager at Walmart?")

I'm working on a blog post concerning functional sympatholysis, a concept which has been conspicuous by its absence w.r.t. several patients who have sought treatment for POTS. If this were working correctly I think their problems would be decidedly less severe. This happens to tie in with recent research on cellular hypoxia and purinergic signalling.
 

Justin30

Senior Member
Messages
1,065
What is wrong with people on this planet wasting money on research like this?

I just dont know what to say as they pray on the sick and weak....keep then housebound...ruin their lives....etc.

And why so you dont have to help them....so you gleem glory in their suffering and pat your egos little back....live a day in our shoes

This world makes me sick some days!
 

JaimeS

Senior Member
Messages
3,408
Location
Silicon Valley, CA
I was wondering about why publish research like this. Here's my answer.
  1. It took a day to write this up.
  2. Look! Name under publication. Forward email congratulating me for publishing to boss / head of dept
  3. Job safe for another day!
  4. Back to actual research that has actual scientific merit
van der Meer, for one, has done some actually useful studies once in awhile.

With the 'publish or perish' model, scientists definitely feel pressured to put their name on something, anything... And more frequently than is logistically possible. But bureaucrats don't know how long actual, high-quality research takes, so.

It's like so much in the world of work, today: just do it faster. 'Better' is immaterial, especially when there are so few who are qualified or educated enough to really judge the merit of scientific work.

-J