Orthostatic Intolerance in Adults Reporting Long COVID Symptoms Was Not Associated With Postural Orthostatic Tachycardia Syndrome

Ann Monaghan, Glenn Jennings, Feng Xue, Lisa Byrne, Eoin Duggan, Roman Romero-Ortuno, Ann Monaghan, Glenn Jennings, Feng Xue, Lisa Byrne, Eoin Duggan, Roman Romero-Ortuno

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).

Keywords: haemodynamics; long COVID; orthostatic intolerance; postural orthostatic tachycardia syndrome; tilt table test.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Monaghan, Jennings, Xue, Byrne, Duggan and Romero-Ortuno.

Figures

FIGURE 1
FIGURE 1
∣ Haemodynamic visualisation of OIAS (n = 56) and non-OIAS (n = 29) groups. (A) Systolic blood pressure (SBP). (B) Diastolic blood pressure (DBP). (C) Heart rate (HR). (D) Tissue saturation index (TSI). bpm, beats per minute; CI, confidence interval.

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