Passive standing tests for the office diagnosis of postural tachycardia syndrome: New methodological considerations

Roma, Maria; Marden, Colleen L.; Rowe, Peter C.

doi:10.1080/21641846.2018.1512836

Cited by 19 publications

(24 citation statements)

References 21 publications

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“…A two-minute test would miss 55% (95% CI, 48–63%), emphasizing the limitations of POTS prevalence estimates based on abbreviated orthostatic testing. The median time to reaching HR criteria for POTS during tilt testing was 3 min, identical to the findings of Roma and colleagues in younger individuals who were studied using a passive standing test ( 24 ). We found no differences in the time to reaching the HR criteria for POTS based on age, sex, duration of ME/CFS, or the end-tidal CO2 levels at the end of the 10 min upright.…”

Section: Discussionsupporting

confidence: 84%

“…The time to reaching HR criteria for POTS in our study among adults was the same as that for a primarily adolescent and young adult population. However, the proportion with a peak HR of 120 bpm or higher in the first 5 min of tilt was 47%, which compares to just 26% in the Roma study ( 24 ). Plash and colleagues reported a mean HR increase for those with POTS that was five beats higher after 5 min of upright tilt than after the same period of active standing, although this difference did not reach statistical significance until participants with POTS and healthy controls were combined ( 17 ).…”

Section: Discussionmentioning

confidence: 55%

“…Roma and colleagues have recently reported that an abbreviated 2-min test would miss 53% of those who ultimately satisfy heart rate criteria for POTS over 10 min of passive standing ( 24 ). In that study of young people (median age 17 years) the median time to POTS was 3 min.…”

Section: Introductionmentioning

confidence: 99%

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Low Sensitivity of Abbreviated Tilt Table Testing for Diagnosing Postural Tachycardia Syndrome in Adults With ME/CFS

Campen¹,

Rowe

Visser³

2018

Front. Pediatr.

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Introduction: Orthostatic intolerance is common among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). In some ME/CFS case definitions, orthostatic intolerance is considered a core feature of the disorder. Some studies have employed tilt table tests lasting 2–5 min to diagnose one common form of orthostatic intolerance, postural tachycardia syndrome (POTS). We examined the diagnostic yield of abbreviated durations of tilt testing in adults meeting criteria for ME/CFS, and identified the proportion with POTS misdiagnosed using testing of <10 min.Methods: Eligible participants were consecutive individuals satisfying study criteria for ME/CFS and POTS evaluated at the Stichting CardioZorg (SCZ, Hoofddorp, NL) between November 2012 and August 2018. Individuals being treated with medications commonly used to manage orthostatic intolerance were excluded. Head-up tilt table testing involved 15 min of supine posture then 20 min at 70 degrees upright. Only the data from the first 10-min upright were used. POTS was defined as an increase in HR during a maximum of 10 min of upright tilt of at least 30 beats per minute (bpm), in the absence of either classical or delayed orthostatic hypotension. We measured the time until HR criteria for POTS were reached using survival curves, and compared survival curves between subgroups divided by age, sex, disease duration, and degree of hypocapnia during the test.Results: Of 627 individuals with ME/CFS evaluated during the study period, 155 met criteria for POTS. The median time to reaching HR criteria for POTS was 3 min. A two-minute tilt table test would miss 55% (95% CI, 48–63%) of those meeting POTS criteria over the course of 10 min upright. The median time to reaching HR criteria for POTS did not differ by sex, age, duration of ME/CFS, or hypocapnia during tilt.Conclusions: Abbreviated tilt table testing misses a substantial proportion of those ultimately diagnosed with POTS during a 10-min tilt table test, and should be abandoned for the clinical diagnosis and in epidemiologic studies designed to estimate the prevalence of POTS among those with ME/CFS.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 55%

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Low Sensitivity of Abbreviated Tilt Table Testing for Diagnosing Postural Tachycardia Syndrome in Adults With ME/CFS

Campen¹,

Rowe

Visser³

2018

Front. Pediatr.

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“…Orthostatic intolerance was considered present if (a) self-reported lightheadedness occurred at least several times per week, (b) there was a history of recurrent syncope in the presence of a structurally normal heart, considered consistent with NMH (34) or (c) previous upright tilt testing or a passive standing testing (performed in patients not being treated with medications for orthostatic intolerance) had confirmed the presence of NMH or POTS. Among individuals not previously diagnosed with or under treatment for orthostatic intolerance, we conducted further orthostatic testing using a passive standing test, methods for the performance of which along with study definitions for POTS and NMH are described elsewhere (35).…”

Section: Methodsmentioning

confidence: 99%

Impaired Health-Related Quality of Life in Adolescent Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The Impact of Core Symptoms

et al. 2019

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Objective: The objectives of this study were to compare the health-related quality of life (HRQOL) of a North American population of adolescents and young adults with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) to (1) healthy controls (HC), (2) adolescents with ME/CFS in other countries, and (3) other forms of pediatric chronic illness, and (4) to examine the influence of the core illness symptoms in the Institute of Medicine (IOM) case definition on impaired HRQOL. Study design: Cross-sectional study comparing individuals with ME/CFS referred to a tertiary care Chronic Fatigue clinic and HC. Eligible participants were age 10–30 years and met the Fukuda criteria for CFS. HC were eligible if they were age 10–30 years, with self-reported good, very good, or excellent general health. Pediatric HRQOL was measured using the PedsQL (Pediatric Quality of Life Inventory) and other validated instruments. Results: We enrolled 55 consecutive ME/CFS patients (46 F) aged 10–23 years. From a pool of 69 potential HC we selected 55 with similar age and gender distribution for comparison. The total and subscale scores on the PedsQL and on all other measures of HRQOL indicated significantly worse function among those with ME/CFS (all P < 0.001). The self-reported frequency of post-exertional malaise (PEM) was significantly associated with the severity of impaired HRQOL ( P < 0.001). Cognitive impairment had a weaker association with the PedsQL score ( P = 0.02). Orthostatic intolerance was present in 96% of the ME/CFS population. Of the 55 who satisfied the Fukuda criteria, 47 (85%) also satisfied the IOM criteria for the diagnosis. Those meeting the IOM criteria had worse PedsQL total scores than those meeting just the Fukuda criteria ( P < 0.001). Conclusions: HRQOL was substantially lower in an ambulatory population of adolescents and young adults with ME/CFS than for healthy controls in North America, consistent with reports from other continents. HRQOL was also lower in ME/CFS than has been described in children with asthma, diabetes mellitus, epilepsy, eosinophilic gastroenteritis, and cystic fibrosis. The findings of this study lend further support to the inclusion of PEM, cognitive impairment, and orthostatic intolerance as core symptoms of pediatric ME/CFS.

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“…The AST, a modification of the passive standing test performed by Roma and colleagues, 16 was administered by the primary clinic nurse. Total duration of the AST was at least 17 minutes, including 10 minutes of orthostatic challenge.…”

Section: Methodsmentioning

confidence: 99%

Screening for Orthostatic Intolerance in Symptomatic Children Presenting for Concussion Care

Kokorelis

Slomine

Rowe

et al. 2019

Clin Pediatr (Phila)

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Following concussion, children often experience nonspecific symptoms that overlap with those of other common pediatric conditions, including orthostatic intolerance (OI). The primary goal of this study was to evaluate OI in youth presenting for clinical care for concussion and reporting symptoms frequently observed in OI. Eighty-two of 114 patients aged 10 to 22 years endorsed symptoms based on 8 screening questions, and 24 of those 82 patients met criteria for OI based on an active standing test. No screening question generated clinically useful likelihood ratios for predicting OI. The prevalence of OI in this cohort is considerably higher than estimates in the general pediatric population, suggesting a link between concussion and OI. Future work is needed to evaluate the best method of testing for OI, the natural history of OI symptoms in youth with concussion, and the response to intervention in children with both concussion and OI.

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Passive standing tests for the office diagnosis of postural tachycardia syndrome: New methodological considerations

Cited by 19 publications

References 21 publications

Low Sensitivity of Abbreviated Tilt Table Testing for Diagnosing Postural Tachycardia Syndrome in Adults With ME/CFS

Low Sensitivity of Abbreviated Tilt Table Testing for Diagnosing Postural Tachycardia Syndrome in Adults With ME/CFS

Impaired Health-Related Quality of Life in Adolescent Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: The Impact of Core Symptoms

Screening for Orthostatic Intolerance in Symptomatic Children Presenting for Concussion Care

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