Chronic fatigue syndrome, orthostatic intolerance and the effect of compression stockings on hemodynamics: a retrospective study.

Abstract

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a clinically defined syndrome that can be severely debilitating. Although the etiology of ME/CFS remains unknown, orthostatic intolerance is a well-recognized pathophysiological mechanism. Previous studies showed that abnormalities in hemodynamics related to orthostatic intolerance could be treated effectively, and that lower body compression application in particular is effective in this respect. In healthy subjects compression stockings showed to improve venous flow effectively. To date however, the effect of below-knee compression stockings on hemodynamics has not been studied in patients with ME/CFS. Purpose: To determine the effect of graduated below-knee compression stockings (18-24 mmHg) on hemodynamics during orthostatic stress in patients with ME/CFS. Methods: A retrospective study design was used. Clinical data from medical files were obtained. Medical files of patients diagnosed with ME/CFS (Fukuda 1994 criteria) where data of hemodynamics from a double tilt-table test (one with and one without below-knee compression application) were available were searched and screened for eligibility. Hemodynamic outcomes were blood pressure, heart rate, stroke volume index and cardiac index. Results: 15 eligible cases were found and included. A consistent but non-significant increase in stroke volume index and cardiac index was found during tilt table tests with compression compared to without compression. A trend (p < 0.10) was found however during the tilt-table test with compression for the improvement of stroke volume index during supine position compared to no compression. No significant results were found for blood pressure and heart rate. Conclusions: Graduated below-knee compression stockings of 18-24 mmHg do not seem to improve hemodynamics during orthostatic stress in patients diagnosed with ME/CFS.