Key result
Longer disease duration is linked to a ~71% drop in POTS prevalence over time.
Why the study?
POTS and orthostatic hypotension have been described early after COVID-19 infection, and the authors hypothesized that orthostatic intolerance decreases over time.
Does the type of orthostatic intolerance and cerebral blood flow abnormality change over time in long-haul COVID-19 patients?
Cross-Sectional (n=29)
No
Does the type of orthostatic intolerance and cerebral blood flow abnormality change over time in long-haul COVID-19 patients?
p-value: p=<0.0001
Orthostatic intolerance in long-haul COVID-19 appears to evolve over time, transitioning from predominantly POTS early on to normal hemodynamics or orthostatic hypotension later, though cerebral blood flow abnormalities persist.
May support time-dependent monitoring of orthostatic intolerance in long-haul COVID; leaves open whether persistent cerebral blood flow changes require intervention.
Background: Postural orthostatic tachycardia syndrome (POTS) has been described early after the onset of the COVID-19 infection, but also orthostatic hypotension (OH). In the present study, we hypothesized that orthostatic intolerance decreases over time. Methods: In 29 long-haul COVID-19 (LHC) patients, a tilt test was performed, including measurements of cerebral blood flow (CBF) by extracranial Doppler. The time interval between the onset of infection and the tilt test varied between 3 and 28 months. Results: In the first 12 months after the infection, 71% of the LHC patients showed POTS and after 24 months none of them. In the first 12 months, 29% of patients had a normal heart rate and blood pressure response (normHRBP) and after 24 months 75% (distribution of POTS, OH, and a normHRBP over time: p < 0.0001). Linear regression showed that, over time, there was a decrease in the abnormal CBF during the tilt (p = 0.024) but remained abnormal. Conclusion: In LHC patients, hemodynamic abnormalities of a tilt test change over time. Patients studied early after the onset of the disease mainly exhibit POTS, but patients studied later in the time course mainly show a normHRBP or OH. In addition, the abnormal CBF reduction improves over time, but CBF remains abnormal.
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Campen et al. (2022) conducted a cross-sectional in Long-haul COVID-19 (n=29). Time elapsed since COVID-19 infection was evaluated on Distribution of postural orthostatic tachycardia syndrome (POTS), orthostatic hypotension (OH), and normal heart rate and blood pressure response over time (p=<0.0001). The hemodynamic profile during tilt testing changed significantly over time, with POTS prevalence decreasing from 71% in the first 12 months to 0% after 24 months (p<0.0001), while abnormal cerebral blood flow reduction improved but persisted (p=0.024).
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