Abstract
In this observational cross-sectional study, we investigated predictors of orthostatic intolerance (OI) in adults reporting long COVID symptoms. Participants underwent a 3-min active stand (AS) with Finapres® NOVA, followed by a 10-min unmedicated 70° head-up tilt test. Eighty-five participants were included (mean age 46 years, range 25–78; 74% women), of which 56 (66%) reported OI during AS (OIAS). OIAS seemed associated with female sex, more fatigue and depressive symptoms, and greater inability to perform activities of daily living (ADL), as well as a higher heart rate (HR) at the lowest systolic blood pressure (SBP) point before the first minute post-stand (mean HRnadir: 88 vs. 75 bpm, P = 0.004). In a regression model also including age, sex, fatigue, depression, ADL inability, and peak HR after the nadir SBP, HRnadir was the only OIAS predictor (OR = 1.09, 95% CI: 1.01–1.18, P = 0.027). Twenty-two (26%) participants had initial (iOH) and 5 (6%) classical (cOHAS) orthostatic hypotension, but neither correlated with OIAS. Seventy-one participants proceeded to tilt, of which 28 (39%) had OI during tilt (OItilt). Of the 53 who had a 10-min tilt, 7 (13%) had an HR increase >30 bpm without cOHtilt (2 to HR > 120 bpm), but six did not report OItilt. In conclusion, OIAS was associated with a higher initial HR on AS, which after 1 min equalised with the non-OIAS group. Despite these initial orthostatic HR differences, POTS was infrequent (2%). ClinicalTrials.gov Identifier: NCT05027724 (retrospectively registered on August 30, 2021).
Highlights
Long COVID or post-COVID-19 syndrome first gained recognition among social support groups and later in scientific and medical communities (Yong, 2021)
For the active stand (AS), we modelled the peak heart rate (HR) after the nadir systolic blood pressure (SBP), defined as the maximum of the HR readings obtained at 1, 2, and 3 min
A fifth were on antidepressant medications and less than 20% were on antihypertensives, beta blockers, or benzodiazepines
Summary
Long COVID or post-COVID-19 syndrome first gained recognition among social support groups and later in scientific and medical communities (Yong, 2021). The neurological and cardiovascular overlap in some long COVID symptoms, and in particular the reported occurrence of orthostatic intolerance (OI) (Dani et al, 2021; Paterson et al, 2021; Shah et al, 2021), have raised the hypothesis as to whether some long COVID patients could have measurable autonomic nervous system impairments (Del Rio et al, 2020; Goldstein, 2020; Keyhanian et al, 2020; Barizien et al, 2021; Becker, 2021; Larsen et al, 2021) such as orthostatic hypotension (OH) or postural orthostatic tachycardia syndrome (POTS) (Blitshteyn and Whitelaw, 2021; Johansson et al, 2021; Raj et al, 2021). We conducted a cross-sectional observational study on a cohort of participants reporting long COVID symptoms to fulfil the following objectives: (1) establish the prevalence of OI, both during an active stand (AS) test and a tilt test; (2) establish the prevalence of OH and POTS in this cohort; and (3) study haemodynamic and non-haemodynamic predictors of OI
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