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Prospective Evaluation of Autonomic Dysfunction in Post-Acute Sequela of COVID-19, 2022, Sameer M Jamal et al

Discussion in 'Long Covid research' started by Mij, Apr 6, 2022.

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  1. Mij

    Mij Senior Member (Voting Rights)

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    8,329
    Abstract

    Background: Patients with 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.

    Objective: We performed head-up tilt table (HUTT) testing in symptomatic Post-Acute Sequela of COVID-19 (PASC) patients 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 one orthostatic hypotension. Compared to those with POTS, patients with POI described significantly earlier improvement of symptoms.

    Conclusions: This prospective evaluation of HUTT in PASC patients 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.

    https://pubmed.ncbi.nlm.nih.gov/35381331/
     
    Mij, Apr 6, 2022
    #1
    ahimsa, Sean, Hutan and 5 others like this.
  2. Hutan

    Hutan Moderator Staff Member

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    Location:
    Aotearoa New Zealand
    It's open access, although it took me a little while to find a link to a Journal pre-proof. Some bits that I thought were interesting:

    So, patients tested did not have the symptoms prior to the Covid-19 infection. They were however selected on the basis of having a confirmed Covid-19 infection and the patient reporting tachycardia with minimal activity or positional change and 'poor exertion intolerance' subsequent to that. Poor exertion intolerance wasn't defined in more detail. The tilt table test was done at approximately 6 months.

    They report 23 out of the 24 having signs of orthostatic intolerance. The "POI" is provoked orthostatic intolerance - i.e. after the administration of 0.4mg sublingual nitroglycerin (NTG) tablet with continuation of a 15-minute observation component while at a 70 degree tilt. I don't know how healthy people respond to such a stimulus. The study doesn't have controls or tell us what percentage of healthy people have POI.

    At 9 months, all of the people with provoked orthostatic intolerance (edit - at 6 months) reported symptoms had gone or were improving.


    I think this is an interesting preliminary study. It would be great to see a longitudinal study of people infected with Covid-19, with measures of orthostatic intolerance made monthly to see if such measures track the development of ME/CFS compliant Long Covid.
     
    Last edited: Apr 9, 2022
    Hutan, Apr 8, 2022
    #2
    ahimsa, Trish, Wyva and 3 others like this.

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