Milovanovic, Branislav, Markovic, Nikola, Petrovic, Masa et al. · Journal of clinical medicine · 2025 · DOI
This study examined how the autonomic nervous system (the part that controls heart rate, blood pressure, and other automatic functions) works differently in people with ME/CFS compared to healthy people. Researchers tested 440 people, including those with ME/CFS from unknown causes and those whose ME/CFS developed after COVID-19, using heart and blood pressure monitoring tests. They found that both ME/CFS groups had significant problems with autonomic function and experienced fainting or near-fainting episodes at high rates, though the post-COVID group showed somewhat different patterns.
This study provides objective physiological evidence that autonomic dysfunction is a core feature of ME/CFS regardless of cause, which validates patient experiences of fainting and orthostatic symptoms. The identification of distinct hemodynamic patterns in post-COVID ME/CFS may help explain why these patients sometimes present differently and could inform future targeted treatments. These findings strengthen the case for autonomic dysfunction testing as a diagnostic tool in ME/CFS evaluation.
This study does not prove that autonomic dysfunction causes ME/CFS—only that it is associated with the condition; the direction of causation remains unclear. It does not establish whether the observed autonomic abnormalities persist long-term or respond to treatment, as it is a single-timepoint cross-sectional design. The study cannot determine whether autonomic testing should replace or supplement existing ME/CFS diagnostic criteria.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Milovanovic, Branislav, Markovic, Nikola, Petrovic, Masa, Zugic, Vasko, Ostojic, Milijana, Rankovic-Nicic, Ljiljana, et al. (2025). Assessment of Autonomic Nervous System Function in Patients with Chronic Fatigue Syndrome and Post-COVID-19 Syndrome Presenting with Recurrent Syncope.. Journal of clinical medicine. https://doi.org/10.3390/jcm14030811
BibTeX
@article{mecfsatlas-milovanovic-2025-assessment-autonomic,
author = {Milovanovic, Branislav and Markovic, Nikola and Petrovic, Masa and Zugic, Vasko and Ostojic, Milijana and Rankovic-Nicic, Ljiljana and Bojic, Milovan},
title = {Assessment of Autonomic Nervous System Function in Patients with Chronic Fatigue Syndrome and Post-COVID-19 Syndrome Presenting with Recurrent Syncope.},
journal = {Journal of clinical medicine},
year = {2025},
doi = {10.3390/jcm14030811},
note = {PubMed: 39941481},
url = {https://www.mecfsatlas.com/evidence/milovanovic-2025-assessment-autonomic},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/milovanovic-2025-assessment-autonomic
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