Orthostatic Challenge Causes Distinctive Symptomatic, Hemodynamic and Cognitive Responses in Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Vernon, Suzanne D.; Funk, Sherlyn; Bateman, Lucinda; Stoddard, Gregory J.; Hammer, Sarah K.; Sullivan, Karen A.; Bell, Jennifer; Abbaszadeh, Saeed; Lipkin, W. Ian; Komaroff, Anthony L.

doi:10.3389/fmed.2022.917019

Cited by 16 publications

(23 citation statements)

References 60 publications

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“…Many researchers have commented on the similarity between ME/CFS and long COVID 99 ; around half of individuals with long COVID are estimated to meet the criteria for ME/CFS 10 , 11 , 29 , 100 , and in studies where the cardinal ME/CFS symptom of postexertional malaise is measured, a majority of individuals with long COVID report experiencing postexertional malaise 7 , 100 . A study of orthostatic stress in individuals with long COVID and individuals with ME/CFS found similar haemodynamic, symptomatic and cognitive abnormalities in both groups compared with healthy individuals 101 . Importantly, it is not surprising that ME/CFS should stem from SARS-CoV-2 infection as 27.1% of SARS-CoV infection survivors in one study met the criteria for ME/CFS diagnosis 4 years after onset 102 .…”

Section: Major Findingsmentioning

confidence: 91%

Long COVID: major findings, mechanisms and recommendations

Davis¹,

McCorkell²,

et al. 2023

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Long COVID is an often debilitating illness that occurs in at least 10% of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. More than 200 symptoms have been identified with impacts on multiple organ systems. At least 65 million individuals worldwide are estimated to have long COVID, with cases increasing daily. Biomedical research has made substantial progress in identifying various pathophysiological changes and risk factors and in characterizing the illness; further, similarities with other viral-onset illnesses such as myalgic encephalomyelitis/chronic fatigue syndrome and postural orthostatic tachycardia syndrome have laid the groundwork for research in the field. In this Review, we explore the current literature and highlight key findings, the overlap with other conditions, the variable onset of symptoms, long COVID in children and the impact of vaccinations. Although these key findings are critical to understanding long COVID, current diagnostic and treatment options are insufficient, and clinical trials must be prioritized that address leading hypotheses. Additionally, to strengthen long COVID research, future studies must account for biases and SARS-CoV-2 testing issues, build on viral-onset research, be inclusive of marginalized populations and meaningfully engage patients throughout the research process.

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Section: Major Findingsmentioning

confidence: 91%

Long COVID: major findings, mechanisms and recommendations

Davis¹,

McCorkell²,

et al. 2023

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“…Narrow PP has previously been reported as low in long covid patients during an NLT, 33 Vernon et al reported a significantly lower mean PP (20% of systolic BP at 10 min) compared to those with ME/CFS and the control group (29% of SBP at 10 min). There are studies suggesting an association between narrow PP and reduced cerebral blood flow in chronic fatigue patients 40,41 .…”

Section: Discussionmentioning

confidence: 86%

“…19,31,38 Whilst estimates of OH in long covid vary from 4% to 28%, our results are comparable to similarly-aged cohorts. 23,31 Some differences in estimated prevalence can be explained by different lean test protocols, for example, restricted diets, 33 which are not practical for routine clinic assessments. We applied commonly used criteria for PoTS, but implementation varies internationally.…”

Section: Additional Findingsmentioning

confidence: 99%

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Prevalence of orthostatic intolerance in long covid clinic patients and healthy volunteers: A multicenter study

Lee,

Greenwood,

Master

et al. 2024

Journal of Medical Virology

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Orthostatic intolerance (OI), including postural orthostatic tachycardia syndrome (PoTS) and orthostatic hypotension (OH), are often reported in long covid, but published studies are small with inconsistent results. We sought to estimate the prevalence of objective OI in patients attending long covid clinics and healthy volunteers and associations with OI symptoms and comorbidities. Participants with a diagnosis of long covid were recruited from eight UK long covid clinics, and healthy volunteers from general population. All undertook standardized National Aeronautics and Space Administration Lean Test (NLT). Participants' history of typical OI symptoms (e.g., dizziness, palpitations) before and during the NLT were recorded. Two hundred seventy‐seven long covid patients and 50 frequency‐matched healthy volunteers were tested. Healthy volunteers had no history of OI symptoms or symptoms during NLT or PoTS, 10% had asymptomatic OH. One hundred thirty (47%) long covid patients had previous history of OI symptoms and 144 (52%) developed symptoms during the NLT. Forty‐one (15%) had an abnormal NLT, 20 (7%) met criteria for PoTS, and 21 (8%) had OH. Of patients with an abnormal NLT, 45% had no prior symptoms of OI. Relaxing the diagnostic thresholds for PoTS from two consecutive abnormal readings to one abnormal reading during the NLT, resulted in 11% of long covid participants (an additional 4%) meeting criteria for PoTS, but not in healthy volunteers. More than half of long covid patients experienced OI symptoms during NLT and more than one in 10 patients met the criteria for either PoTS or OH, half of whom did not report previous typical OI symptoms. We therefore recommend all patients attending long covid clinics are offered an NLT and appropriate management commenced.

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“…A test reported recently [ 52 ] that can be performed even more simply in a clinician’s office is an orthostatic stress challenge that shows different symptomatic, hemodynamic, and cognitive abnormalities in people with Long COVID and ME/CFS, compared with healthy controls. Coupled to a smartphone app to assess cognition, it can provide objective confirmation of the orthostatic intolerance and brain fog reported by patients with Long COVID and ME/CFS.…”

Section: The Search For a Simple Universal Diagnostic Test For Me/cfsmentioning

confidence: 99%

Towards a Better Understanding of the Complexities of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Long COVID

Tate

Walker

Peppercorn

et al. 2023

IJMS

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Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a complex condition arising in susceptible people, predominantly following viral infection, but also other stressful events. The susceptibility factors discussed here are both genetic and environmental although not well understood. While the dysfunctional physiology in ME/CFS is becoming clearer, understanding has been hampered by different combinations of symptoms in each affected person. A common core set of mainly neurological symptoms forms the modern clinical case definition, in the absence of an accessible molecular diagnostic test. This landscape has prompted interest in whether ME/CFS patients can be classified into a particular phenotype/subtype that might assist better management of their illness and suggest preferred therapeutic options. Currently, the same promising drugs, nutraceuticals, or behavioral therapies available can be beneficial, have no effect, or be detrimental to each individual patient. We have shown that individuals with the same disease profile exhibit unique molecular changes and physiological responses to stress, exercise and even vaccination. Key features of ME/CFS discussed here are the possible mechanisms determining the shift of an immune/inflammatory response from transient to chronic in ME/CFS, and how the brain and CNS manifests the neurological symptoms, likely with activation of its specific immune system and resulting neuroinflammation. The many cases of the post viral ME/CFS-like condition, Long COVID, following SARS-CoV-2 infection, and the intense research interest and investment in understanding this condition, provide exciting opportunities for the development of new therapeutics that will benefit ME/CFS patients.

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Orthostatic Challenge Causes Distinctive Symptomatic, Hemodynamic and Cognitive Responses in Long COVID and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Cited by 16 publications

References 60 publications

Long COVID: major findings, mechanisms and recommendations

Long COVID: major findings, mechanisms and recommendations

Prevalence of orthostatic intolerance in long covid clinic patients and healthy volunteers: A multicenter study

Towards a Better Understanding of the Complexities of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Long COVID

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