Case-control study of autonomic symptoms in the setting of Long COVID with tilt table testing, 2025, Durstenfeld, Henrich, Deeks, Hsue+

[SNT Gatchaman]

Case-control study of autonomic symptoms in the setting of Long COVID with tilt table testing

Spoiler: Authors

Matthew S Durstenfeld; Nirosh Mataraarachchi; Michael J Peluso; Marta Levkova-Clark; Veronica Schaffer; Emily A Fehrman; Grace Anderson; Diana Flores; Timothy J Henrich; Carlin S Long; Steven G Deeks; Priscilla Y Hsue

BACKGROUND
Autonomic symptoms and orthostatic syndromes have been reported in Long COVID, but few studies have characterized findings using head up tilt table testing.

OBJECTIVE
To characterize autonomic responses to positional changes among individuals with Long COVID.

METHODS
We assessed autonomic symptoms using the Composite Autonomic Symptom Scale 31 (COMPASS 31) instrument and performed head up tilt table testing for 30 minutes at 70 degrees among individuals with Long COVID and recovered comparators.

RESULTS
We included 26 participants (median age 56 years, 50% female median 25 months after first COVID): 16 with Long COVID and 10 recovered comparators. COMPASS 31 scores (0–100, higher is worse) were higher among those with Long COVID (median 30.5 vs 8, p = 0.003). Heart rate was 8 beats per minutes higher throughout tilt among those with Long COVID (95% CI 1.1 to 14.4; p = 0.02); there were no differences in blood pressure. Ten (63%) with Long COVID had symptoms during tilt compared to none among recovered participants (p = 0.003). Three (19%) with Long COVID had clinically abnormal findings: one each with orthostatic hypotension, and delayed orthostatic hypotension, and cardioinhibitory/vasovagal presyncope.

CONCLUSIONS
Among those with chronic autonomic symptoms in the setting of Long COVID, symptoms were common during tilt testing, and heart rate was increased, but most did not meet diagnostic criteria for a clinically abnormal hemodynamic response. Further research into mechanisms of autonomic symptoms in Long COVID is urgently needed.

Web | PDF | PLOS ONE | Open Access

 

[Utsikt]

For the “case” group, we specifically recruited individuals who had participated in the LIINC cardiovascular sub-study who reported at least one cardiovascular Long COVID symptom including chest pain, dyspnea, palpitations, fatigue, or decreased exercise capacity and who answered “Yes” to a survey question at least 3 months after COVID: “Do you have any symptoms when you change positions?”

No wonder they found symptoms in some if they asked for it when recruiting..

From the same cohort, we recruited a sample of adults with at least one cardiovascular Long COVID symptom including chest pain, dyspnea, palpitations, fatigue, and decreased exercise capacity who answered “No” to the survey question.

And no wonder there were some without symptoms if they also used that as a recruitment criteria!

Finally, we recruited a sample of individuals recovered from COVID-19 who reported that they had fully recovered from COVID without any persistent symptoms as a comparator group, matched by age within five years and sex to the “case” group.

And no wonder the controls didn’t have symptoms if that was used as an inclusion criteria!

The abstract starts to look very weird in light of all this, although they kind or acknowledge it in the discussions and limitations:

Our case-control design and recruitment strategy does not allow estimation of prevalence estimates of Long COVID-POTS within the community, so this remains an outstanding research need.

Our primary limitations arise from our small sample size and case-control design (which limits our ability to comment on prevalence).

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Like several other small studies [9,10,20], we found that orthostatic symptoms were common during HUTT even without meeting clinical criteria for an abnormal heart rate or blood pressure response during HUTT.

I wish we got more info about the symptoms. This is from the supplements:

COMPASS 31 scores and orthostatic domain scores by screening questionnaire for symptoms with position change.

Boxplots of COMPASS 31 Total Score and Orthostatic Domain Scores by Recovered (blue, left), Long COVID with “No” answer to question about symptoms with position change (lavendar, middle), and Long COVID with “Yes” answer to question about symptoms with position change (orange, right).

I can’t open this file on mobile, so there might be something there?

OSF

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