Naschitz, J E, Rosner, I, Rozenbaum, M et al. · QJM : monthly journal of the Association of Physicians · 2003 · DOI
Researchers developed a simple test using a tilting table to measure how well the body controls blood pressure and heart rate in ME/CFS patients. By tilting people upright and measuring these vital signs, they found a pattern (called a haemodynamic instability score) that appeared in ME/CFS patients but not in healthy people or those with other conditions. This test could help doctors confirm an ME/CFS diagnosis with objective measurements rather than relying only on symptoms.
This study offers the first objective physiological biomarker for ME/CFS diagnosis, addressing the long-standing clinical challenge of confirming diagnosis through subjective symptom assessment alone. The ability to distinguish ME/CFS dysautonomia from other conditions (fibromyalgia, anxiety, syncope) could accelerate diagnosis and reduce diagnostic delays, while providing a measurable endpoint for future treatment studies.
This study does not prove that HIS abnormalities cause ME/CFS or that they are specific to ME/CFS pathophysiology; it only demonstrates correlation with diagnosis. The cross-sectional design cannot establish whether HIS changes are fundamental to disease or secondary manifestations. Furthermore, the 22% test incompletion rate suggests the score may not be useful for more severely affected patients, and validation in independent cohorts is needed before clinical implementation.
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
Naschitz, J E, Rosner, I, Rozenbaum, M, Naschitz, S, Musafia-Priselac, R, Shaviv, N, et al. (2003). The head-up tilt test with haemodynamic instability score in diagnosing chronic fatigue syndrome.. QJM : monthly journal of the Association of Physicians. https://doi.org/10.1093/qjmed/hcg018
BibTeX
@article{mecfsatlas-naschitz-2003-head-tilt-2,
author = {Naschitz, J E and Rosner, I and Rozenbaum, M and Naschitz, S and Musafia-Priselac, R and Shaviv, N and Fields, M and Isseroff, H and Zuckerman, E and Yeshurun, D and Sabo, E},
title = {The head-up tilt test with haemodynamic instability score in diagnosing chronic fatigue syndrome.},
journal = {QJM : monthly journal of the Association of Physicians},
year = {2003},
doi = {10.1093/qjmed/hcg018},
note = {PubMed: 12589011},
url = {https://www.mecfsatlas.com/evidence/naschitz-2003-head-tilt-2},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-30. https://www.mecfsatlas.com/evidence/naschitz-2003-head-tilt-2
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