Objective cardiovascular autonomic abnormalities persist over time in patients with Post-Acute Sequelae of COVID-19 (PASC)
Bibliographic record
Abstract
BACKGROUND: The novel coronavirus (SARS-CoV-2) has negatively impacted the health and economy of the world. While most patients recover, many are suffering from symptoms several months after resolution of the acute illness (“Post-Acute Sequalae of COVID-19” [PASC]). Symptoms include fatigue, light-headedness, and tachycardia/palpitations, similar to symptoms of cardiovascular autonomic disorders such as Postural Orthostatic Tachycardia Syndrome (POTS), Initial Orthostatic Hypotension (IOH), Orthostatic Hypotension (OH), and Inappropriate Sinus Tachycardia (IST). We have previously shown a high prevalence of autonomic abnormalities among PASC patients. We currently do not know if these autonomic abnormalities are chronic and persist in PASC patients over time. OBJECTIVE: We aimed to determine if the autonomic abnormalities seen in patients after COVID-19 infection are persistent or transient, by comparing hemodynamic criterion between baseline and follow-up visits. We hypothesize that patients will recover, and abnormalities will not persist between the visits. METHODS: PASC patients (n=64; F=51; 46±12y) completed baseline visits 411±133 days after their initial COVID-19 infection and follow-up visits 97±9 days later. Patients underwent autonomic function testing with beat-to-beat hemodynamics during 10min supine rest followed by a 10min active stand. Patients were evaluated for hemodynamic criterion for POTS (↑HR≥30bpm within 10min), IOH (transient ↓SBP≥40mmHg within 15s), OH (↓SBP≥20mmHg within 3min), and IST (supine HR>100bpm). Categorical data were analyzed with a McNemar’s test. RESULTS: 19 (30%) participants met POTS criterion at baseline vs. 15 (23%) at follow-up (p=0.1). 43 (67%) participants met IOH criterion at baseline vs. 37 (58%) at follow-up (p=0.08). The OH criterion was seen in 2 (3.1%) vs 5 (7.8%) patients (p=0.2) and IST was seen in 1 patient at both visits (1.6%). Overall, 48 (75%) patients met the hemodynamic criterion for at least one autonomic disorder at baseline and 43 (67%) patients met at least one criterion at follow-up (p=0.09). CONCLUSION: Many patients with PASC have evidence of cardiovascular autonomic abnormalities, most commonly IOH, followed by POTS. The prevalence of these abnormalities does not decrease over time. These findings suggest patients with PASC are not recovering from autonomic complications due to their COVID-19 infections. Treatment and management strategies for autonomic abnormalities are needed to improve the quality of life for these patients. Funding: Canadian Institutes of Health Research (CIHR) This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".