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Quantitative Autonomic Testing
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Association of Autonomic Dysfunction With Long COVID: Evaluation Using Quantitative Autonomic Testing.

Ciana Keller1, Lorraine Mascarenhas2, Jorge L Reyes3

  • 1Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.

Journal of the American College of Cardiology
|December 10, 2025
PubMed
Summary
This summary is machine-generated.

Long COVID patients show significant autonomic dysfunction, comparable to those with pure autonomic failure. This persistent dysfunction impacts heart rate and blood pressure regulation long after initial infection.

Keywords:
Valsalva maneuveractive standingautonomic dysfunctionlong COVIDpure autonomic failurerespiratory sinus arrhythmiatilt-table testing

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Area of Science:

  • Cardiology
  • Neurology
  • Infectious Disease

Background:

  • Long COVID syndrome, characterized by persistent symptoms post-COVID-19 infection, is suspected to involve autonomic dysfunction.
  • The precise nature and severity of autonomic disturbances in long COVID remain unclear.

Purpose of the Study:

  • To compare autonomic function in patients with long COVID, healthy controls, and individuals with established pure autonomic failure.
  • To elucidate the extent of autonomic impairment in long COVID patients.

Main Methods:

  • Autonomic function testing was performed on three groups: long COVID, COVID-19 negative controls, and pure autonomic failure patients.
  • Measurements included heart rate and blood pressure responses during active standing, Valsalva maneuver, respiratory sinus arrhythmia, and tilt-table tests.

Main Results:

  • Long COVID patients exhibited greater heart rate increases and blood pressure drops during active standing and tilt-table tests compared to controls.
  • Patients with long COVID showed reduced Valsalva ratios and respiratory sinus arrhythmia values versus controls.
  • After age and sex adjustment, autonomic dysfunction in long COVID patients was comparable to that in pure autonomic failure patients, persisting up to 40 months post-infection.

Conclusions:

  • Long COVID patients demonstrate persistent autonomic dysfunction.
  • This dysfunction is similar in severity to that observed in patients with pure autonomic failure when adjusted for age and sex.