Postural orthostatic tachycardia is not a useful diagnostic marker for chronic fatigue syndrome.
Roerink, M E, Lenders, J W M, Schmits, I C et al. · Journal of internal medicine · 2017 · DOI
Quick Summary
This study tested whether a condition called POTS (postural orthostatic tachycardia syndrome)—where heart rate increases too much when standing—is a reliable marker for ME/CFS. Researchers found that POTS was equally common in ME/CFS patients and in people with fatigue who don't have ME/CFS, suggesting POTS is not a useful diagnostic tool for ME/CFS. The study did find that adolescents with both conditions responded less well to cognitive behavioral therapy than those with ME/CFS alone.
Why It Matters
This research challenges the assumption that POTS can be used to diagnose or characterize ME/CFS, potentially refocusing diagnostic efforts toward more specific biomarkers. For patients, it clarifies that POTS presence or absence does not define ME/CFS diagnosis. The finding that POTS may predict worse CBT response in adolescents could inform treatment selection and expectations.
Observed Findings
POTS prevalence was 5.7% in adult CFS patients vs. 6.9% in non-CFS fatigued adults (P=0.54), and 18.2% vs. 17.4% in adolescents (P=0.93).
Adult patients with POTS-CFS were significantly younger (30±12 vs. 40±13 years, P=0.001) and had higher supine heart rates (71±11 vs. 65±9 bpm, P=0.009).
Disease severity and activity patterns did not differ significantly between POTS-CFS and non-POTS-CFS groups.
In adolescents, CBT response rates were significantly lower in POTS-CFS (58%) compared to non-POTS-CFS (88%, P=0.017).
76% of adults and 67% of adolescents with CFS met SEID criteria, with POTS prevalence unchanged in this subset.
Inferred Conclusions
POTS is not a useful diagnostic marker for distinguishing CFS from other fatigued states in either adults or adolescents.
POTS presence does not correlate with disease severity, activity limitations, or treatment response in most CFS populations, though it may predict worse CBT outcomes in adolescents.
The evaluation of POTS status has limited clinical value in CFS diagnosis and management.
Remaining Questions
Does POTS represent a distinct pathophysiological subtype of ME/CFS despite similar prevalence rates, and if so, what mechanisms drive the worse CBT response in adolescents with POTS?
What This Study Does Not Prove
This study does not establish whether POTS plays any pathophysiological role in ME/CFS—only that it is not a reliable diagnostic marker. The observational design cannot prove causation or whether POTS subtypes differ between groups. Results from a single Dutch tertiary center may not generalize to other populations or diagnostic settings.
Why is POTS prevalence notably higher in adolescents (18%) than adults (6%) with fatigue, and does this reflect developmental differences in autonomic function?
Could alternative diagnostic criteria or POTS phenotyping (e.g., hyperadrenergic vs. neuropathic subtypes) reveal clinically meaningful associations missed by standard POTS definitions?