Orthostatic Symptoms and Reductions in Cerebral Blood Flow in Long-Haul COVID-19 Patients: Similarities with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. — CFSMEATLAS
Orthostatic Symptoms and Reductions in Cerebral Blood Flow in Long-Haul COVID-19 Patients: Similarities with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.
Campen, C Linda M C van, Rowe, Peter C, Visser, Frans C · Medicina (Kaunas, Lithuania) · 2021 · DOI
Quick Summary
This study compared people with long-haul COVID-19 to people with ME/CFS to see if they experience similar problems with dizziness and blood flow when standing up. Researchers found that long-haul COVID patients had very similar symptoms to ME/CFS patients and showed even greater reductions in blood flow to the brain during tilt testing. The findings suggest that COVID-19 infection may trigger ME/CFS-like illness in some people.
Why It Matters
This study provides direct evidence that long-haul COVID and ME/CFS share similar clinical features and hemodynamic abnormalities, suggesting SARS-CoV-2 may trigger ME/CFS development. Understanding these overlaps could help clinicians recognize and appropriately manage post-viral illnesses and may guide research into common pathological mechanisms.
Observed Findings
All 10 long-haul COVID-19 patients developed POTS during head-up tilt testing.
Cerebral blood flow and cardiac index were significantly more reduced in all three patient groups compared to healthy controls.
Long-haul COVID patients showed larger cerebral blood flow reductions than ME/CFS patients with normal heart rate and blood pressure responses to tilt.
Symptom prevalence on ME/CFS questionnaires was not significantly different between long-haul COVID and ME/CFS patient groups.
Cardiac index reduction was similar across the three patient groups despite differences in heart rate/blood pressure responses.
Inferred Conclusions
Long-haul COVID-19 and ME/CFS share similar symptom profiles and hemodynamic abnormalities during orthostatic stress.
SARS-CoV-2 infection may act as a trigger for ME/CFS development, similar to SARS-CoV-1.
The early onset of orthostatic intolerance and high pre-illness activity levels in long-haul COVID patients suggest POTS is not due to deconditioning.
Cerebral blood flow dysregulation appears to be a key feature of both long-haul COVID and ME/CFS during orthostatic stress.
Remaining Questions
Do long-haul COVID patients progress to meet formal ME/CFS diagnostic criteria over time, and what proportion develop chronic ME/CFS?
What This Study Does Not Prove
This study does not prove that COVID-19 definitively causes ME/CFS, only that similarities exist between the two conditions. The small sample size and cross-sectional design limit generalizability. The study does not establish whether the cerebral blood flow reductions cause the symptoms or are secondary findings.
Tags
Symptom:Orthostatic IntoleranceFatigue
Biomarker:Neuroimaging
Phenotype:Infection-TriggeredLong COVID Overlap
Method Flag:PEM Not DefinedSmall SampleStrong Phenotyping
What are the underlying mechanisms causing the cerebral blood flow reductions—are they related to viral persistence, autoimmunity, autonomic dysfunction, or other pathology?
Why do some COVID-19 patients develop these orthostatic symptoms while others do not, and what are the risk factors?
Would treatments targeting orthostatic intolerance or cerebral blood flow dysregulation be effective for long-haul COVID patients?