tetano
Editor, Senior Moderator
Heart Rhythm
. 2021 Dec 9;S1547-5271(21)02430-9.
doi: 10.1016/j.hrthm.2021.12.005. Online ahead of print.
Dysautonomia following COVID-19 is not associated with subjective limitations or symptoms, but is associated with objective functional limitations
Peter Ladlow[SUP] 1 [/SUP], Oliver O'Sullivan[SUP] 2 [/SUP], Andrew Houston[SUP] 3 [/SUP], Robert Barker-Davies[SUP] 4 [/SUP], Samantha May[SUP] 3 [/SUP], Daniel Mills[SUP] 3 [/SUP], Dominic Dewson[SUP] 3 [/SUP], Rebecca Chamley[SUP] 5 [/SUP], Jon Naylor[SUP] 6 [/SUP], Joseph Mulae[SUP] 6 [/SUP], Alexander N Bennett[SUP] 7 [/SUP], Edward D Nicol[SUP] 8 [/SUP], David A Holdsworth[SUP] 9 [/SUP]
Affiliations
Abstract
Background: Individuals who contract coronavirus disease 2019 (COVID-19) can suffer with persistent and debilitating symptoms long after the initial acute illness. Heart rate (HR) profiles determined during cardiopulmonary exercise testing (CPET) and delivered as part of a post-COVID recovery service may provide an insight into presence and impact of dysautonomia on functional ability.
Objective: Using an active, working age, post-COVID-19 population, the aim was to: 1) understand and characterise any association between subjective symptoms and dysautonomia, and 2) identify objective exercise capacity differences between patients classified 'with' and 'without' dysautonomia.
Methods: Patients referred to a post-COVID-19 service underwent comprehensive clinical assessment, including self-reported symptoms, CPET and secondary care investigations when indicated. Resting HR >75 beats per minute (bpm), HR increase with exercise <89bpm, and HR recovery <25bpm one minute after exercise were used to define dysautonomia. Anonymised data were analysed and associations with symptoms and CPET outcomes determined.
Results: Fifty-one (25%) of the 205 patients reviewed as part of this service evaluation had dysautonomia. There were no associations between symptoms or perceived functional limitation and dysautonomia (p>0.05). Patients with dysautonomia demonstrated objective functional limitations with significantly reduced work rate (219±37 W vs. 253±52 W, p<0.001), peak oxygen consumption (V̇O[SUB]2[/SUB]: 30.6±5.5 ml/kg/min vs. 35.8±7.6 ml/kg/min, p<0.001) and a steeper (less efficient) V̇E/V̇CO[SUB]2[/SUB] slope (29.9±4.9 vs. 27.7±4.7, p=0.005).
Conclusion: Dysautonomia is associated with objective functional limitations but is not associated with subjective symptoms or limitation.
Keywords: COVID-19; CPET; dysautonomia; exercise testing; symptoms.
. 2021 Dec 9;S1547-5271(21)02430-9.
doi: 10.1016/j.hrthm.2021.12.005. Online ahead of print.
Dysautonomia following COVID-19 is not associated with subjective limitations or symptoms, but is associated with objective functional limitations
Peter Ladlow[SUP] 1 [/SUP], Oliver O'Sullivan[SUP] 2 [/SUP], Andrew Houston[SUP] 3 [/SUP], Robert Barker-Davies[SUP] 4 [/SUP], Samantha May[SUP] 3 [/SUP], Daniel Mills[SUP] 3 [/SUP], Dominic Dewson[SUP] 3 [/SUP], Rebecca Chamley[SUP] 5 [/SUP], Jon Naylor[SUP] 6 [/SUP], Joseph Mulae[SUP] 6 [/SUP], Alexander N Bennett[SUP] 7 [/SUP], Edward D Nicol[SUP] 8 [/SUP], David A Holdsworth[SUP] 9 [/SUP]
Affiliations
- PMID: 34896622
- DOI: 10.1016/j.hrthm.2021.12.005
Abstract
Background: Individuals who contract coronavirus disease 2019 (COVID-19) can suffer with persistent and debilitating symptoms long after the initial acute illness. Heart rate (HR) profiles determined during cardiopulmonary exercise testing (CPET) and delivered as part of a post-COVID recovery service may provide an insight into presence and impact of dysautonomia on functional ability.
Objective: Using an active, working age, post-COVID-19 population, the aim was to: 1) understand and characterise any association between subjective symptoms and dysautonomia, and 2) identify objective exercise capacity differences between patients classified 'with' and 'without' dysautonomia.
Methods: Patients referred to a post-COVID-19 service underwent comprehensive clinical assessment, including self-reported symptoms, CPET and secondary care investigations when indicated. Resting HR >75 beats per minute (bpm), HR increase with exercise <89bpm, and HR recovery <25bpm one minute after exercise were used to define dysautonomia. Anonymised data were analysed and associations with symptoms and CPET outcomes determined.
Results: Fifty-one (25%) of the 205 patients reviewed as part of this service evaluation had dysautonomia. There were no associations between symptoms or perceived functional limitation and dysautonomia (p>0.05). Patients with dysautonomia demonstrated objective functional limitations with significantly reduced work rate (219±37 W vs. 253±52 W, p<0.001), peak oxygen consumption (V̇O[SUB]2[/SUB]: 30.6±5.5 ml/kg/min vs. 35.8±7.6 ml/kg/min, p<0.001) and a steeper (less efficient) V̇E/V̇CO[SUB]2[/SUB] slope (29.9±4.9 vs. 27.7±4.7, p=0.005).
Conclusion: Dysautonomia is associated with objective functional limitations but is not associated with subjective symptoms or limitation.
Keywords: COVID-19; CPET; dysautonomia; exercise testing; symptoms.