{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:45:23Z","timestamp":1787161523165,"version":"build-2736575974"},"reference-count":29,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T00:00:00Z","timestamp":1699920000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Despite the prevalence of dysautonomia in people with Long COVID, it is currently unknown whether Long COVID dysautonomia is routinely accompanied by structural or functional cardiac alterations. In this retrospective observational study, the presence of echocardiographic abnormalities was assessed. Left ventricular (LV) chamber sizes were correlated to diagnostic categories and symptoms via standardized patient-reported outcome (PRO) questionnaires. A total of 203 individuals with Long COVID without pre-existing cardiac disease and with available echocardiograms were included (mean age, 45 years; 67% female). Overall, symptoms and PRO scores for fatigue, breathlessness, quality of life, disability, anxiety and depression were not different between those classified with post-COVID dysautonomia (PCD, 22%) and those unclassified (78%). An LV internal diameter at an end-diastole z score &lt; \u22122 was observed in 33 (16.5%) individuals, and stroke volume (SV) was lower in the PCD vs. unclassified subgroup (51.6 vs. 59.2 mL, 95% C.I. 47.1\u201356.1 vs. 56.2\u201362.3). LV end-diastolic volume (mean diff. (95% CI) \u221213 [\u22121\u2013\u221226] mL, p = 0.04) and SV (\u221210 [\u22121\u2013\u221220] mL, p = 0.03) were smaller in those individuals reporting a reduction in physical activity post-COVID-19 infection, and smaller LVMI was weakly correlated with worse fatigue (r = 0.23, p = 0.02). The majority of individuals with Long COVID report shared symptoms and did not demonstrate cardiac dysfunction on echocardiography.<\/jats:p>","DOI":"10.3390\/jpm13111606","type":"journal-article","created":{"date-parts":[[2023,11,14]],"date-time":"2023-11-14T02:20:37Z","timestamp":1699928437000},"page":"1606","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Dysautonomia, but Not Cardiac Dysfunction, Is Common in a Cohort of Individuals with Long COVID"],"prefix":"10.3390","volume":"13","author":[{"given":"Laura","family":"Tabacof","sequence":"first","affiliation":[{"name":"Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamie","family":"Wood","sequence":"additional","affiliation":[{"name":"Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4784-4310","authenticated-orcid":false,"given":"Erica","family":"Breyman","sequence":"additional","affiliation":[{"name":"Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna","family":"Tosto-Mancuso","sequence":"additional","affiliation":[{"name":"Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn","family":"Wilkey","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3536-9524","authenticated-orcid":false,"given":"Chi","family":"Zhang","sequence":"additional","affiliation":[{"name":"Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Putrino","sequence":"additional","affiliation":[{"name":"Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Kontorovich","sequence":"additional","affiliation":[{"name":"Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"The Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"The Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1016\/j.jacc.2020.06.007","article-title":"Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection","volume":"76","author":"Lala","year":"2020","journal-title":"J. Am. Coll Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"107435","DOI":"10.1016\/j.carpath.2022.107435","article-title":"Microthrombosis as a cause of fulminant myocarditis-like presentation with COVID-19 proven by endomyocardial biopsy","volume":"60","author":"Nakatani","year":"2022","journal-title":"Cardiovasc. Pathol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1016\/j.jacc.2021.12.023","article-title":"Anticoagulation in Patients With COVID-19: JACC Review Topic of the Week","volume":"79","author":"Farkouh","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1007\/s00431-020-03766-6","article-title":"Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: A comprehensive review and proposed clinical approach","volume":"180","author":"Sperotto","year":"2021","journal-title":"Eur. J. Pediatr."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e0630","DOI":"10.1097\/CCE.0000000000000630","article-title":"Clinical and Histopathologic Features of Myocarditis in Multisystem Inflammatory Syndrome (Adult)-Associated COVID-19","volume":"10","author":"Aldeghaither","year":"2022","journal-title":"Crit. Care Explor."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1161\/CIRCULATIONAHA.121.056817","article-title":"Prevalence, Characteristics, and Outcomes of COVID-19-Associated Acute Myocarditis","volume":"145","author":"Ammirati","year":"2022","journal-title":"Circulation."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1161\/CIRCULATIONAHA.121.054824","article-title":"SARS-CoV-2 Cardiac Involvement in Young Competitive Athletes","volume":"144","author":"Moulson","year":"2021","journal-title":"Circulation."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1001\/jamacardio.2021.2065","article-title":"Prevalence of Clinical and Subclinical Myocarditis in Competitive Athletes With Recent SARS-CoV-2 Infection: Results From the Big Ten COVID-19 Cardiac Registry","volume":"6","author":"Daniels","year":"2021","journal-title":"JAMA Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1097\/PHM.0000000000001910","article-title":"Post-acute COVID-19 Syndrome Negatively Impacts Physical Function, Cognitive Function, Health-Related Quality of Life, and Participation","volume":"101","author":"Tabacof","year":"2022","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101019","DOI":"10.1016\/j.eclinm.2021.101019","article-title":"Characterizing long COVID in an international cohort: 7 months of symptoms and their impact","volume":"38","author":"Davis","year":"2021","journal-title":"EClinicalMedicine"},{"key":"ref_11","unstructured":"Centers for Disease Control and Prevention (2022, July 25). Nearly One in Five American Adults Who Have Had COVID-19 Still Have \u201cLong COVID\u201d, Available online: https:\/\/www.cdc.gov\/nchs\/pressroom\/nchs_press_releases\/2022\/20220622.htm#."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1007\/s12026-021-09185-5","article-title":"Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: A case series of 20 patients","volume":"69","author":"Blitshteyn","year":"2021","journal-title":"Immunol. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.jaccas.2021.01.009","article-title":"Long-Haul Post-COVID-19 Symptoms Presenting as a Variant of Postural Orthostatic Tachycardia Syndrome: The Swedish Experience","volume":"3","author":"Johansson","year":"2021","journal-title":"JACC Case Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1007\/s00415-021-10735-y","article-title":"Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: A prospective multidomain observational study","volume":"269","author":"Furlanis","year":"2022","journal-title":"J. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1016\/j.jacc.2022.03.357","article-title":"Prospective Evaluation of Autonomic Dysfunction in Post-Acute Sequela of COVID-19","volume":"79","author":"Jamal","year":"2022","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3754","DOI":"10.1002\/ajmg.a.62446","article-title":"Dysautonomia in hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders is associated with exercise intolerance and cardiac atrophy","volume":"185","author":"Fettig","year":"2021","journal-title":"Am. J. Med. Genet. A."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"2858","DOI":"10.1016\/j.jacc.2010.02.043","article-title":"Cardiac origins of the postural orthostatic tachycardia syndrome","volume":"55","author":"Fu","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1002\/ana.26286","article-title":"Multisystem Involvement in Post-Acute Sequelae of Coronavirus Disease 19","volume":"91","author":"Novak","year":"2022","journal-title":"Ann. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1007\/s10286-021-00803-8","article-title":"Autonomic dysfunction following COVID-19 infection: An early experience","volume":"31","author":"Shouman","year":"2021","journal-title":"Clin. Auton. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"833650","DOI":"10.3389\/fphys.2022.833650","article-title":"Orthostatic Intolerance in Adults Reporting Long COVID Symptoms Was Not Associated With Postural Orthostatic Tachycardia Syndrome","volume":"13","author":"Monaghan","year":"2022","journal-title":"Front. Physiol."},{"key":"ref_21","unstructured":"Centers for Disease Control and Prevention (2022, July 25). Post-COVID Conditions: Overview for Healthcare Providers, Available online: https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/hcp\/clinical-care\/post-covid-conditions.html."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/j.hrthm.2020.12.007","article-title":"The possible association between COVID-19 and postural tachycardia syndrome","volume":"18","author":"Goldstein","year":"2021","journal-title":"Heart Rhythm."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1016\/j.jacc.2018.11.059","article-title":"Postural Orthostatic Tachycardia Syndrome: JACC Focus Seminar","volume":"73","author":"Bryarly","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/j.hrthm.2015.12.012","article-title":"The international POTS registry: Evaluating the efficacy of an exercise training intervention in a community setting","volume":"13","author":"George","year":"2016","journal-title":"Heart Rhythm."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1161\/01.HYP.0000156540.25707.af","article-title":"Endurance exercise training in orthostatic intolerance: A randomized, controlled trial","volume":"45","author":"Winker","year":"2005","journal-title":"Hypertension."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1161\/HYPERTENSIONAHA.111.172262","article-title":"Exercise training versus propranolol in the treatment of the postural orthostatic tachycardia syndrome","volume":"58","author":"Fu","year":"2011","journal-title":"Hypertension"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1097\/01.JAA.0000481398.76099.09","article-title":"Recognizing postural orthostatic tachycardia syndrome","volume":"29","author":"Pavlik","year":"2016","journal-title":"JAAPA"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1270","DOI":"10.1002\/pmrj.12894","article-title":"Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of autonomic dysfunction in patients with post-acute sequelae of SARS-CoV-2 infection (PASC)","volume":"14","author":"Blitshteyn","year":"2022","journal-title":"PMR"}],"container-title":["Journal of Personalized Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/11\/1606\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:22:34Z","timestamp":1760131354000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4426\/13\/11\/1606"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,14]]},"references-count":29,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2023,11]]}},"alternative-id":["jpm13111606"],"URL":"https:\/\/doi.org\/10.3390\/jpm13111606","relation":{},"ISSN":["2075-4426"],"issn-type":[{"value":"2075-4426","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,14]]}}}