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ArticleClinical autonomic research : official journal of the Clinical Autonomic Research Society2025

Attenuated cardiac autonomic function in patients with long-COVID with impaired orthostatic hemodynamics.

Rashmin Hira, Jacquie R Baker, Tanya Siddiqui, Aishani Patel, Felix Gabriel Ayala Valani, Matthew G Lloyd, John S Floras, Carlos A Morillo, Robert S Sheldon, Satish R Raj and 1 more

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Article in Clinical autonomic research : official journal of the Clinical Autonomic Research Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

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0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Rashmin HiraDepartment of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, GAC70 HRIC Building, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
Jacquie R BakerDepartment of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, GAC70 HRIC Building, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
Tanya SiddiquiDepartment of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, GAC70 HRIC Building, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
Aishani PatelDepartment of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, GAC70 HRIC Building, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
Felix Gabriel Ayala ValaniDepartment of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, GAC70 HRIC Building, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
Matthew G LloydDepartment of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, GAC70 HRIC Building, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
John S FlorasDepartment of Medicine, University Health Network and Sinai Health, University of Toronto, Toronto, ON, Canada.
Carlos A MorilloDepartment of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, GAC70 HRIC Building, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
Robert S SheldonDepartment of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, GAC70 HRIC Building, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada.
Satish R RajDepartment of Cardiac Sciences, Libin Cardiovascular Institute, University of Calgary, GAC70 HRIC Building, 3280 Hospital Dr NW, Calgary, AB, T2N 4Z6, Canada. satish.raj@ucalgary.ca.ORCID http://orcid.org/0000-0002-5890-3785
Canadian Long COVID Autonomic Network (CanLoCAN)

Funding

CIHR G4A- 177741Vanderbilt Institute for Clinical and Translational Research NIH UL1-TR000445
6 · The paper itself

Abstract

purposeLong-coronavirus disease (long-COVID) is associated with initial orthostatic hypotension and postural orthostatic tachycardia syndrome. Whether altered autonomic tone underlies these abnormalities is unknown. We compared autonomic function between patients with long-COVID and healthy controls, and within patients with long-COVID with different orthostatic hemodynamic phenotypes.

methodsPatients with long-COVID (n = 94; F = 76; 42 years [36, 53 years] with initial orthostatic hypotension: n = 40; F = 32; 49 years [39, 57 years]; postural orthostatic tachycardia syndrome: n = 29; F = 26; 39 years [33, 47 years]; or no abnormalities: n = 25; F = 18; 42 years [35, 49 years]), and healthy controls (n = 33; F = 25; 49 years [30, 62 years]) completed a 10-min active stand with beat-to-beat hemodynamics. Heart rate variability, blood pressure variability, and baroreflex sensitivity were calculated as indirect measures of cardiovascular autonomic health. Continuous data (median [95% confidence interval]) were analyzed with Mann-Whitney U tests or Kruskal-Wallis tests with Dunn's corrections.

resultsPatients with long-COVID had lower upright high frequency heart rate variability (p = 0.04) and low frequency blood pressure variability (p = 0.001) than controls. Patients with initial orthostatic hypotension had lower supine baroreflex sensitivity compared with patients without abnormalities (p = 0.01), and lower supine baroreflex sensitivity (p = 0.001) and high frequency heart rate variability (p = 0.03) than patients with postural orthostatic tachycardia syndrome. Patients with postural orthostatic tachycardia syndrome had lower upright high frequency heart rate variability (p < 0.001) and baroreflex sensitivity (p < 0.001) compared with patients without abnormalities and lower upright low frequency blood pressure variability (p = 0.04) compared with controls.

conclusionsPatients with long-COVID have attenuated cardiac autonomic function. Patients with initial orthostatic hypotension have lower supine baroreflex sensitivity. Patients with postural orthostatic tachycardia syndrome have lower upright vascular sympathetic and cardiac parasympathetic modulation. Long-COVID subgroups do not present with homogeneous pathophysiology, necessitating targeted treatment strategies.

Indexed as

Autonomic Nervous SystemCOVID-19HemodynamicsHypotension, OrthostaticPostural Orthostatic Tachycardia SyndromeAdultBaroreflexBlood PressureFemaleHeart RateHumansMaleMiddle AgedAutonomicBaroreflex sensitivityBlood pressure variabilityHeart rate variabilityLong-COVID

Identifiers

What Socratic holds

Textmetadata
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.