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Prospective Evaluation of Autonomic Dysfunction in Post-Acute Sequela of COVID-19.
J Am Coll Cardiol. 2022 06 14; 79(23):2325-2330.JACC

Abstract

BACKGROUND

Patients with post-acute sequela of COVID-19 (PASC) often report symptoms of orthostatic intolerance and autonomic dysfunction. Numerous case reports link postural orthostatic tachycardia syndrome (POTS) to PASC. No prospective analysis has been performed.

OBJECTIVES

This study performed head-up tilt table (HUTT) testing in symptomatic patients with PASC to evaluate for orthostatic intolerance suggestive of autonomic dysfunction.

METHODS

We performed a prospective, observational evaluation of patients with PASC complaining of poor exertional tolerance, tachycardia with minimal activity or positional change, and palpitations. Exclusion criteria included pregnancy, pre-PASC autonomic dysfunction or syncope, or another potential explanation of PASC symptoms. All subjects underwent HUTT.

RESULTS

Twenty-four patients with the described PASC symptoms were included. HUTT was performed a mean of 5.8 ± 3.5 months after symptom onset. Twenty-three of the 24 had orthostatic intolerance on HUTT, with 4 demonstrating POTS, 15 provoked orthostatic intolerance (POI) after nitroglycerin, 3 neurocardiogenic syncope, and 1 orthostatic hypotension. Compared with those with POTS, patients with POI described significantly earlier improvement of symptoms.

CONCLUSIONS

This prospective evaluation of HUTT in patients with PASC revealed orthostatic intolerance on HUTT suggestive of autonomic dysfunction in nearly all subjects. Those with POI may be further along the path of clinical recovery than those demonstrating POTS.

Links

Authors+Show Affiliations

Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA. Electronic address: Sameer.jamal@hmhn.org.

Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA.

Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA.

Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA.

Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA.

Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA.

Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA.

MeSH

COVID-19Heart RateHumansOrthostatic IntolerancePostural Orthostatic Tachycardia SyndromeTilt-Table Test

Pub Type(s)

Journal Article

Observational Study

Language

eng

PubMed ID

35381331

Citation

Jamal, Sameer M., et al. "Prospective Evaluation of Autonomic Dysfunction in Post-Acute Sequela of COVID-19." Journal of the American College of Cardiology, vol. 79, no. 23, 2022, pp. 2325-2330.

Jamal SM, Landers DB, Hollenberg SM, et al. Prospective Evaluation of Autonomic Dysfunction in Post-Acute Sequela of COVID-19. J Am Coll Cardiol. 2022;79(23):2325-2330.

Jamal, S. M., Landers, D. B., Hollenberg, S. M., Turi, Z. G., Glotzer, T. V., Tancredi, J., & Parrillo, J. E. (2022). Prospective Evaluation of Autonomic Dysfunction in Post-Acute Sequela of COVID-19. Journal of the American College of Cardiology, 79(23), 2325-2330. https://doi.org/10.1016/j.jacc.2022.03.357

Jamal SM, et al. Prospective Evaluation of Autonomic Dysfunction in Post-Acute Sequela of COVID-19. J Am Coll Cardiol. 2022 06 14;79(23):2325-2330. PubMed PMID: 35381331.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Prospective Evaluation of Autonomic Dysfunction in Post-Acute Sequela of COVID-19. AU - Jamal,Sameer M, AU - Landers,David B, AU - Hollenberg,Steven M, AU - Turi,Zoltan G, AU - Glotzer,Taya V, AU - Tancredi,Jana, AU - Parrillo,Joseph E, Y1 - 2022/04/02/ PY - 2022/01/31/received PY - 2022/03/08/revised PY - 2022/03/28/accepted PY - 2022/4/6/pubmed PY - 2022/6/14/medline PY - 2022/4/5/entrez KW - head-up tilt table (HUTT) KW - neurocardiogenic syncope KW - orthostatic hypotension KW - orthostatic intolerance KW - postural orthostatic tachycardic syndrome (POTS) SP - 2325 EP - 2330 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 79 IS - 23 N2 - BACKGROUND: Patients with post-acute sequela of COVID-19 (PASC) often report symptoms of orthostatic intolerance and autonomic dysfunction. Numerous case reports link postural orthostatic tachycardia syndrome (POTS) to PASC. No prospective analysis has been performed. OBJECTIVES: This study performed head-up tilt table (HUTT) testing in symptomatic patients with PASC to evaluate for orthostatic intolerance suggestive of autonomic dysfunction. METHODS: We performed a prospective, observational evaluation of patients with PASC complaining of poor exertional tolerance, tachycardia with minimal activity or positional change, and palpitations. Exclusion criteria included pregnancy, pre-PASC autonomic dysfunction or syncope, or another potential explanation of PASC symptoms. All subjects underwent HUTT. RESULTS: Twenty-four patients with the described PASC symptoms were included. HUTT was performed a mean of 5.8 ± 3.5 months after symptom onset. Twenty-three of the 24 had orthostatic intolerance on HUTT, with 4 demonstrating POTS, 15 provoked orthostatic intolerance (POI) after nitroglycerin, 3 neurocardiogenic syncope, and 1 orthostatic hypotension. Compared with those with POTS, patients with POI described significantly earlier improvement of symptoms. CONCLUSIONS: This prospective evaluation of HUTT in patients with PASC revealed orthostatic intolerance on HUTT suggestive of autonomic dysfunction in nearly all subjects. Those with POI may be further along the path of clinical recovery than those demonstrating POTS. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/35381331/Prospective_Evaluation_of_Autonomic_Dysfunction_in_Post_Acute_Sequela_of_COVID_19_ DB - PRIME DP - Unbound Medicine ER -