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

Jamal, Sameer; Landers, David; Hollenberg, Steven M.; Turi, Zoltan G.; Glotzer, Taya V.; Tancredi, Jana; Parrillo, Joseph E.

doi:10.1016/j.jacc.2022.03.357

Cited by 76 publications

(67 citation statements)

References 24 publications

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“…Finally, evidence of autonomic dysfunction in PASC is further supported by recent studies suggesting that some patients present with signs and symptoms suggestive of postural orthostatic tachycardia syndrome (49). Indeed, postural orthostatic tachycardia syndrome can explain the CPET findings as it is associated with sympathetic stimulation, vasoconstriction, and hyperpnea (50).…”

Section: Discussionmentioning

confidence: 71%

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Exercise Intolerance in Post-Acute Sequelae of COVID-19 and the Value of Cardiopulmonary Exercise Testing- a Mini-Review

et al. 2022

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Coronavirus disease (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with systemic organ damage in the most severe forms. Long-term complications of SARS-CoV-2 appear to be restricted to severe presentations of COVID-19, but many patients with persistent symptoms have never been hospitalized. Post-acute sequelae of COVID-19 (PASC) represents a heterogeneous group of symptoms characterized by cardiovascular, general, respiratory, and neuropsychiatric sequelae. The pace of evidence acquisition with PASC has been rapid, but the mechanisms behind it are complex and not yet fully understood. In particular, exercise intolerance shares some features with other classic respiratory and cardiac disorders. However, cardiopulmonary exercise testing (CPET) provides a comprehensive assessment and can unmask the pathophysiological mechanism behind exercise intolerance in gray-zone PASC. This mini-review explores the utility of CPET and aims to provide a comprehensive assessment of PASC by summarizing the current evidence.

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Section: Discussionmentioning

confidence: 71%

“…Interestingly, there is growing evidence that autonomic dysfunction might a fundamental factor in the observed symptoms in PASC-CVS (49). Theoretically, we could speculate about the potential utility of HR dynamics assessment in this group of patients during maximal effort and recovery.…”

Section: Prognostic Utility Of Cpet In Pasc-cvsmentioning

confidence: 87%

Exercise Intolerance in Post-Acute Sequelae of COVID-19 and the Value of Cardiopulmonary Exercise Testing- a Mini-Review

et al. 2022

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“…Orthostatic cerebral hypoperfusion syndrome [18], small fiber neuropathy [18][19][20], orthostatic hypotension and intolerance [21,22], postural orthostatic tachycardia syndrome (POTS) [19,23], altered pupillary reactivity [24], and heart rate variability (HRV) [25] are the most common symptoms that may last for several weeks or months after the infection recovery in approximately 33-87% of patients [26]. This condition is known as post-COVID-19 syndrome or "long COVID".…”

Section: Introductionmentioning

confidence: 99%

Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review

Scala

Rizzo

Bellavia

et al. 2022

JCM

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Although autonomic dysfunction (AD) after the recovery from Coronavirus disease 2019 (COVID-19) has been thoroughly described, few data are available regarding the involvement of the autonomic nervous system (ANS) during the acute phase of SARS-CoV-2 infection. The primary aim of this review was to summarize current knowledge regarding the AD occurring during acute COVID-19. Secondarily, we aimed to clarify the prognostic value of ANS involvement and the role of autonomic parameters in predicting SARS-CoV-2 infection. According to the PRISMA guidelines, we performed a systematic review across Scopus and PubMed databases, resulting in 1585 records. The records check and the analysis of included reports’ references allowed us to include 22 articles. The studies were widely heterogeneous for study population, dysautonomia assessment, and COVID-19 severity. Heart rate variability was the tool most frequently chosen to analyze autonomic parameters, followed by automated pupillometry. Most studies found ANS involvement during acute COVID-19, and AD was often related to a worse outcome. Further studies are needed to clarify the role of autonomic parameters in predicting SARS-CoV-2 infection. The evidence emerging from this review suggests that a complex autonomic nervous system imbalance is a prominent feature of acute COVID-19, often leading to a poor prognosis.

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“…While our inability to qualitatively replicate these clusters across variants may indicate our own power limitations, they may also reflect differences in underlying processes related to the variants’ properties. Some of these rarer symptoms have previously been reported in relation to Long COVID phenotypes 40, 45 .…”

Section: Discussionmentioning

confidence: 78%

Profiling post-COVID syndrome across different variants of SARS-CoV-2

Canas

Molteni

Deng

et al. 2022

Preprint

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Background: Self-reported symptom studies rapidly increased our understanding of SARS-CoV-2 during the pandemic and enabled the monitoring of long-term effects of COVID-19 outside the hospital setting. It is now evident that post-COVID syndrome presents with heterogeneous profiles, which need characterisation to enable personalised care among the most affected survivors. This study describes post-COVID profiles, and how they relate to different viral variants and vaccination status. Methods: In this prospective longitudinal cohort study, we analysed data from 336,652 subjects, with regular health reports through the Covid Symptom Study (CSS) smartphone application. These subjects had reported feeling physically normal for at least 30 days before testing positive for SARS-CoV-2. 9,323 individuals subsequently developed Long-COVID, defined as symptoms lasting longer than 28 days. 1,459 had post-COVID syndrome, defined as more than 12 weeks of symptoms. Clustering analysis of the time-series data was performed to identify distinct symptom profiles for post-COVID patients, across variants of SARS-CoV-2 and vaccination status at the time of infection. Clusters were then characterised based on symptom prevalence, duration, demography, and prior conditions (comorbidities). Using an independent testing sample with additional data (n=140), we investigated the impact of post-COVID symptom clusters on the lives of affected individuals. Findings: We identified distinct profiles of symptoms for post-COVID syndrome within and across variants: four endotypes were identified for infections due to the wild-type variant; seven for the alpha variant; and five for delta. Across all variants, a cardiorespiratory cluster of symptoms was identified. A second cluster related to central neurological, and a third to cases with the most severe and debilitating multi-organ symptoms. Gastrointestinal symptoms clustered in no more than two specific phenotypes per viral variant. The three main clusters were confirmed in an independent testing sample, and their functional impact was assessed. Interpretation: Unsupervised analysis identified different post-COVID profiles, characterised by differing symptom combinations, durations, and functional outcomes. Phenotypes were at least partially concordant with individuals reported experiences. Our classification may be useful to understand distinct mechanisms of the post-COVID syndrome, as well as subgroups of individuals at risk of prolonged debilitation. Funding: UK Government Department of Health and Social Care, Chronic Disease Research Foundation, The Wellcome Trust, UK Engineering and Physical Sciences Research Council, UK Research and Innovation London Medical Imaging & Artificial Intelligence Centre for Value-Based Healthcare, UK National Institute for Health Research, UK Medical Research Council, British Heart Foundation and Alzheimers Society, and ZOE Limited, UK.

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

Cited by 76 publications

References 24 publications

Exercise Intolerance in Post-Acute Sequelae of COVID-19 and the Value of Cardiopulmonary Exercise Testing- a Mini-Review

Exercise Intolerance in Post-Acute Sequelae of COVID-19 and the Value of Cardiopulmonary Exercise Testing- a Mini-Review

Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review

Profiling post-COVID syndrome across different variants of SARS-CoV-2

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