Differences In Cardiovascular Autonomic Dysfunction Between Postural Tachycardia Syndrome And Long COVID-19 Postural Tachycardia Syndrome: A Prospective Cohort Study

Post-acute sequelae of COVID-19 infection or Long COVID-19 is a debilitating condition affecting 140 million US adults. Some Long COVID-19 patients develop cardiovascular autonomic dysfunction, particularly Postural Tachycardia Syndrome or POTS. It is unknown, however, if there are differences in cardiovascular autonomic reflexes, autonomic symptoms, or quality of life between these populations. We prospectively enrolled 42 patients (20 Long COVID-19 POTS and 22 POTS patients), 93% (39 of 42) females referred to the Vanderbilt Autonomic Dysfunction Clinic. These patients underwent standardized autonomic function testing, including head-up tilt (HUT), Valsalva maneuver (VM) and Sinus arrhythmia (SA). Autonomic symptoms were measured with COMPASS-31 survey, and quality of life assessment with EQ-5D. Results: Both groups were matched by age (37 ± 11.3 vs. 33 ± 9.3, p=0.393) and BMI (29 ± 7.5 vs. 30 ± 7.6, p=0.951). Supine SBP (p=0.145), DBP (p=0.258) and HR (p=0.130) were similar between groups. The increase in HR during 10-min HUT were similar between groups (Figure A), and upright HR absolute values were slightly but significantly lower in Long COVID-19 POTS than in POTS patients (100 ± 16.7 vs. 109 ± 27.5, p=0.04). Sympathetic vasoconstriction and cardiovagal function were similar between groups with no differences during VM and SA, respectively. Long COVID-19 POTS had a greater COMPASS-31 total score (80 ± 12.9 vs. 48 ± 8.8 in POTS, p=0.001), affecting all 6 domains (Figure B). EQ-5D was similar between groups (p =0.692). Conclusion: Autonomic symptoms were disproportionately higher in Long-COVID-19 POTS than in POTS, despite similar cardiovascular autonomic reflexes.