Prospective Evaluation of Autonomic Dysfunction in Post-Acute Sequela of COVID-19

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 exertionat 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. (C) 2022 by the American College of Cardiology Foundation.

Automated summary

This study performed head-up tilt table (HUTT) testing in symptomatic patients with post-acute sequela of COVID-19 (PASC), revealing orthostatic intolerance suggestive of autonomic dysfunction in nearly all subjects. Patients with provoked orthostatic intolerance (POI) showed earlier improvement of symptoms compared to those with postural orthostatic tachycardia syndrome (POTS).