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Detecting Orthostatic Intolerance in Long COVID in a Clinic Setting, 2023, Isaac et al.

Discussion in 'Long Covid research' started by SNT Gatchaman, May 27, 2023.

  1. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

    Aotearoa New Zealand
    Detecting Orthostatic Intolerance in Long COVID in a Clinic Setting
    Isaac, Robert Oliver; Corrado, Joanna; Sivan, Manoj

    A likely mechanism of Long COVID (LC) is dysautonomia, manifesting as orthostatic intolerance (OI). In our LC service, all patients underwent a National Aeronautics and Space Administration (NASA) Lean Test (NLT), which can detect OI syndromes of Postural Tachycardia Syndrome (PoTS) or Orthostatic Hypotension (OH) in a clinic setting. Patients also completed the COVID-19 Yorkshire Rehabilitation Scale (C19-YRS), a validated LC outcome measure. Our objectives in this retrospective study were (1) to report on the findings of the NLT; and (2) to compare findings from the NLT with LC symptoms reported on the C19-YRS.

    NLT data, including maximum heart rate increase, blood pressure decrease, number of minutes completed and symptoms experienced during the NLT were extracted retrospectively, together with palpitation and dizziness scores from the C19-YRS. Mann-Witney U tests were used to examine for statistical difference in palpitation or dizziness scores between patients with normal NLT and those with abnormal NLT. Spearman’s rank was used to examine the correlation between the degree of postural HR and BP change with C19-YRS symptom severity score.

    Results: Of the 100 patients with LC recruited, 38 experienced symptoms of OI during the NLT; 13 met the haemodynamic screening criteria for PoTS and 9 for OH. On the C19-YRS, 81 reported dizziness as at least a mild problem, and 68 for palpitations being at least a mild problem. There was no significant statistical difference between reported dizziness or palpitation scores in those with normal NLT and those with abnormal NLT. The correlation between symptom severity score and NLT findings was <0.16 (poor).

    We have found evidence of OI, both symptomatically and haemodynamically in patients with LC. The severity of palpitations and dizziness reported on the C19-YRS does not appear to correlate with NLT findings. We would recommend using the NLT in all LC patients in a clinic setting, regardless of presenting LC symptoms, due to this inconsistency.

    Link | PDF (International Journal of Environmental Research and Public Health)
    Mij, RedFox, ahimsa and 4 others like this.
  2. Trish

    Trish Moderator Staff Member

    It's interesting that the conclusion from the poor correlation between results on the NASA lean test and OI symptoms seems to be to believe the veracity of the test rather than the symptoms.

    A more logical conclusion is surely that the NASA test is inadequate and shouldn't be relied on for assessing the cause of OI in a patient as it will miss lots of genuine cases.

    I think it should be checked out with tilt table testing. I'm sure we've seen other research that showed 10 minutes NASA lean test is not reliable at picking up many OI cases.

    Also, POTS and orthostatic hypotension aren't the only forms of genuinely physiological OI.
    sebaaa, DokaGirl, Mij and 9 others like this.
  3. Dolphin

    Dolphin Senior Member (Voting Rights)

    Yes. One study showing this:
    Cerebral blood flow is reduced in ME/CFS during head-up tilt testing even in the absence of hypotension or tachycardia: A quantitative, controlled study using Doppler echography
    C Linda M C van Campen et al. Clin Neurophysiol Pract. 2020.
  4. SNT Gatchaman

    SNT Gatchaman Senior Member (Voting Rights)

    Aotearoa New Zealand
    I thought they covered that in discussion and conclusion. Ref [14] is the study @Dolphin posted above. [6] is Long-Haul COVID Patients: Prevalence of POTS Are Reduced but Cerebral Blood Flow Abnormalities Remain Abnormal with Longer Disease Duration (2022).

  5. DokaGirl

    DokaGirl Senior Member (Voting Rights)

    At least the authors are recommending all pwLC in clinical settings get a Nasa Lean Test.

    PwME are still waiting for this type of recommendation from other than biomedical ME experts. It's been decades in the desert.
    ahimsa, shak8, RedFox and 5 others like this.

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