Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID-19 infection - A systematic review

Diogo Reis Carneiro; Isabel Rocha; Mario Habek; Raimund Helbok; Johann Sellner; Walter Struhal; Gregor Wenning; Alessandra Fanciulli

doi:10.1111/ene.15714

Clinical presentation and management strategies of cardiovascular autonomic dysfunction following a COVID-19 infection - A systematic review

Eur J Neurol. 2023 May;30(5):1528-1539. doi: 10.1111/ene.15714. Epub 2023 Feb 8.

Authors

Diogo Reis Carneiro^{1

2}, Isabel Rocha³, Mario Habek^{4

5}, Raimund Helbok⁶, Johann Sellner^{7

8}, Walter Struhal⁹, Gregor Wenning⁶, Alessandra Fanciulli⁶

Affiliations

¹ Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
² Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
³ Cardiovascular Autonomic Function Lab, Institute of Physiology, CCUL, Faculty of Medicine of University of Lisbon, Lisbon, Portugal.
⁴ Department of Neurology, University Hospital Centre Zagreb, Zagreb, Croatia.
⁵ Department of Neurology, University of Zagreb, School of Medicine, Zagreb, Croatia.
⁶ Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
⁷ Landesklinikum Mistlbach-Gänserndorf, Mistelbach, Austria.
⁸ Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
⁹ Karl Landsteiner University of Health Sciences, Department of Neurology, University Hospital Tulln, Tulln, Austria.

PMID: 36694382
DOI: 10.1111/ene.15714

Abstract

Background: Cardiovascular autonomic dysfunction may reportedly occur after a coronavirus-disease-2019 (COVID-19) infection, but the available evidence is scattered. Here we sought to understand the acute and mid-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on cardiovascular autonomic function.

Methods: We performed a systematic PubMed, Embase, Web of Science, medRxiv, and bioRxiv search for cases of cardiovascular autonomic dysfunction during an acute SARS-CoV-2 infection or post-COVID-19 condition. The clinical-demographic characteristics of individuals in the acute versus post-COVID-19 phase were compared.

Results: We screened 6470 titles and abstracts. Fifty-four full-length articles were included in the data synthesis. One-hundred and thirty-four cases were identified: 81 during the acute SARS-CoV-2 infection (24 thereof diagnosed by history) and 53 in the post-COVID-19 phase. Post-COVID-19 cases were younger than those with cardiovascular autonomic disturbances in the acute SARS-CoV-2 phase (42 vs. 51 years old, p = 0.002) and were more frequently women (68% vs. 49%, p = 0.034). Reflex syncope was the most common cardiovascular autonomic disorder in the acute phase (p = 0.008) and postural orthostatic tachycardia syndrome (POTS) the most frequent diagnosis in individuals with post-COVID-19 orthostatic complaints (p < 0.001). Full recovery was more frequent in individuals with acute versus post-COVID-19 onset of cardiovascular autonomic disturbances (43% vs. 15%, p = 0.002).

Conclusions: There is evidence from the scientific literature about different types of cardiovascular autonomic dysfunction developing during and after COVID-19. More data about the prevalence of autonomic disorders associated with a SARS-CoV-2 infection are needed to quantify its impact on human health.

Keywords: COVID-19; autonomic nervous system; orthostatic hypotension; postural orthostatic tachycardia syndrome; syncope.

Publication types

Systematic Review
Review

MeSH terms

Autonomic Nervous System
Autonomic Nervous System Diseases* / etiology
Autonomic Nervous System Diseases* / therapy
COVID-19* / complications
Female
Humans
Middle Aged
SARS-CoV-2