ME and CFS Medical Abnormalities – Tilt Table Test


Following is a list of articles about abnormalities on the tilt table test in ME and CFS

Links to the more than 1,000 peer-reviewed journal articles are listed on the M.E. and CFS Medical Abnormalities page of this website.


Wyller VB, Due R, Saul JP, Amlie JP, Thaulow E. Usefulness of an abnormal cardiovascular response during low-grade head-up tilt-test for discriminating adolescents with chronic fatigue from healthy controls. Am J Cardiol. 2007 Apr 1;99(7):997-1001. PMID: 17398200

Adolescents with CFS have significant abnormalities of cardiovascular regulation in response to mild orthostatic stress.


Naschitz JE, Mussafia-Priselac R, Kovalev Y, Zaigraykin N, Slobodin G, Elias N, Rosner I. Patterns of hypocapnia on tilt in patients with fibromyalgia, chronic fatigue syndrome, nonspecific dizziness, and neurally mediated syncope. Am J Med Sci. 2006 Jun;331(6):295-303. PMID: 16775435

Hyperventilation appears to be the major abnormal response to postural challenge in sustained hypocapnia. Because unrecognized hypocapnia is common in CFS, fibromyalgia, and nonspecific dizziness, capnography should be a part of the evaluation of patients with such conditions.


Jones JF, Nicholson A, Nisenbaum R, Papanicolaou DA, Solomon L, Boneva R, Heim C, Reeves WC. Orthostatic instability in a population-based study of chronic fatigue syndrome. Am J Med. 2005 Dec;118(12):1415. PMID: 16378795

Orthostatic instability was similar in persons with chronic fatigue syndrome and nonfatigued controls subjects recruited from the general Wichita population. Delayed responses to head-up tilt tests were common and may reflect hydration status.


Yoshiuchi K, Quigley KS, Ohashi K, Yamamoto Y, Natelson BH. Use of time-frequency analysis to investigate temporal patterns of cardiac autonomic response during head-up tilt in chronic fatigue syndrome. Auton Neurosci. 2004 Jun 30;113(1-2):55-62. PMID: 15296795

We studied 18 CFS patients without POTS, eight CFS patients with POTS and 25 sedentary healthy controls during supine rest and during the first 10 min after HUT. Even CFS patients without POTS may have a subtle underlying disturbance in autonomic function.


Razumovsky AY, DeBusk K, Calkins H, Snader S, Lucas KE, Vyas P, Hanley DF, Rowe PC. Cerebral and systemic hemodynamics changes during upright tilt in chronic fatigue syndrome. J Neuroimaging. 2003 Jan;13(1):57-67. PMID: 12593133

Patients with CFS did not have abnormal cerebral blood flow velocity (CBFV) compared with controls in response to orthostatic stress. The median time to hypotension did not differ, but the median time to onset of orthostatic symptoms was shorter in those with CFS.


Yamamoto Y, LaManca JJ, Natelson BH. A measure of heart rate variability is sensitive to orthostatic challenge in women with chronic fatigue syndrome. Exp Biol Med (Maywood). 2003 Feb;228(2):167-74. PMID: 12563023

This study suggests that a decrease in aperiodic fractal component of heart rate variability in response to head up tilt can be used to differentiate patients with CFS from controls.


Naschitz JE, Rosner I, Rozenbaum M, Naschitz S, Musafia-Priselac R, Shaviv N, Fields M, Isseroff H, Zuckerman E, Yeshurun D, Sabo E. The head-up tilt test with haemodynamic instability score in diagnosing chronic fatigue syndrome. QJM. 2003 Feb;96(2):133-42. PMID: 12589011

The authors developed a method that uses a head-up tilt test (HUTT) to estimate blood pressure and heart rate instability during tilt. There is a particular dysautonomia in CFS that differs from dysautonomia in other disorders, characterized by haemodynamic instability score>-0.98. This can reinforce the clinician’s diagnosis by providing objective criteria for the assessment of CFS.


Timmers HJ, Wieling W, Soetekouw PM, Bleijenberg G, Van Der Meer JW, Lenders JW. Hemodynamic and neurohumoral responses to head-up tilt in patients with chronic fatigue syndrome. Clin Auton Res. 2002 Aug;12(4):273-80. PMID: 12357281

Head-up tilt evokes postural tachycardia or (pre)syncope in a minority of CFS patients. In this study, head-up tilt-negative CFS patients had a higher heart rate at baseline together with a marked decrease in stroke volume in response to head-up tilt.


Naschitz JE, Rozenbaum M, Rosner I, Sabo E, Priselac RM, Shaviv N, Ahdoot A, Ahdoot M, Gaitini L, Eldar S, Yeshurun D. Cardiovascular response to upright tilt in fibromyalgia differs from that in chronic fatigue syndrome. J Rheumatol. 2001 Jun;28(6):1356-60. PMID: 11409131

Cardiovascular response during postural challenge were more problematic in CFS patients than in healthy controls or than in fibromyalgia patients.


Karas B, Grubb BP, Boehm K, Kip K. The postural orthostatic tachycardia syndrome: a potentially treatable cause of chronic fatigue, exercise intolerance, and cognitive impairment in adolescents. Pacing Clin Electrophysiol. 2000 Mar;23(3):344-51. PMID: 10750135

POTS may occur in adolescents and represents a mild, potentially treatable form of autonomic dysfunction that can be readily identified during head upright tilt table testing.


LaManca JJ, Peckerman A, Walker J, Kesil W, Cook S, Taylor A, Natelson BH. Cardiovascular response during head-up tilt in chronic fatigue syndrome. Clin Physiol. 1999 Mar;19(2):111-20. PMID: 10200892

This study examined the cardiovascular response to orthostatic challenge, noting differences between patients and controls.


Stewart J, Weldon A, Arlievsky N, Li K, Munoz J. Neurally mediated hypotension and autonomic dysfunction measured by heart rate variability during head-up tilt testing in children with chronic fatigue syndrome. Clin Auton Res. 1998 Aug;8(4):221-30. PMID: 9791743

In a tilt table test, 81% of CFS patients fainted, compared to 30% of controls. Heart rate variability indices were strikingly decreased in CFS patients. These data may indicate autonomic impairment in patients with CFS.


De Becker P, Dendale P, De Meirleir K, Campine I, Vandenborne K, Hagers Y. Autonomic testing in patients with chronic fatigue syndrome. Am J Med. 1998 Sep 28;105(3A):22S-26S. PMID: 9790478

After a tilt table test, CFS patients had abnormally high heart rates and abnormally low frequency power.


De Lorenzo F, Hargreaves J, Kakkar VV. Pathogenesis and management of delayed orthostatic hypotension in patients with chronic fatigue syndrome. Clin Auton Res. 1997 Aug;7(4):185-90. PMID: 9292244

An abnormal response to upright tilt was observed in 22 of 78 patients with CFS. After sodium chloride therapy for 8 weeks, half of patients did not show an abnormal response to the test and reported improvement in CFS symptoms. Patients who did not respond to sodium chloride therapy were found to have low plasma renin activity.


Freeman R, Komaroff AL. Does the chronic fatigue syndrome involve the autonomic nervous system? Am J Med. 1997 Apr;102(4):357-64. PMID: 9217617

CFS subjects had a significant increase in baseline and maximum heart rate (HR) on standing and a tilt table test. Tests of parasympathetic nervous system function were significantly less in the CFS group as were measures of sympathetic nervous system function. Twenty-five percent of CFS subjects had a positive tilt table test. The physical activity index was a significant predictor of autonomic test results; and the blood pressure decrease in phase II of the Valvalsa maneuver, whereas premorbid and coexistent psychiatric conditions were not. The onset of autonomic symptoms occurred within 4 weeks of a viral infection in 46% of patients-a temporal pattern that is consistent with a postviral, idiopathic autonomic neuropathy.


De Lorenzo F, Hargreaves J, Kakkar VV. Possible relationship between chronic fatigue and postural tachycardia syndromes. Clin Auton Res. 1996 Oct;6(5):263-4. PMID: 8899252

Upright tilt-table testing induced significant hypotension and increased heart rate in a group of five CFS patients.


Bou-Holaigah I, Rowe PC, Kan J, Calkins H. The relationship between neurally mediated hypotension and the chronic fatigue syndrome. JAMA. 1995 Sep 27;274(12):961-7. PMID: 7674527

An abnormal response to upright tilt was observed in 22 of 23 patients with chronic fatigue syndrome vs four of 14 controls (P < .001). Seventy percent of chronic fatigue syndrome patients, but no controls, had an abnormal response during stage 1 (P < .001). Nine patients reported complete or nearly complete resolution of chronic fatigue syndrome symptoms after therapy directed at neurally mediated hypotension.


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