Clinical and Immunovirological Characteristics Associated with Cardiovascular Dysautonomia in Long COVID

Renaudineau, Yves; Teillaud, Selena; Chaves, Sébastien De Almeida; Alvarez, Muriel; Barthes, Romain; Bost, Chloé; Fortenfant, Françoise; Puissant-Lubrano, Bénédicte; Abravanel, Florence; Vellas, Camille; Pavy-Le Traon, Anne; Sailler, Laurent

doi:10.3390/jcm15114192

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Clinical and Immunovirological Characteristics Associated with Cardiovascular Dysautonomia in Long COVID

by

Yves Renaudineau

^1,2,†

,

Selena Teillaud

¹

,

Sébastien De Almeida Chaves

³,

Muriel Alvarez

⁴,

Romain Barthes

⁵,

Chloé Bost

^1,2,

Françoise Fortenfant

¹,

Bénédicte Puissant-Lubrano

^1,2,

Florence Abravanel

⁶

,

Camille Vellas

⁶

,

Anne Pavy-Le Traon

⁷ and

Laurent Sailler

^3,*,†

¹

Laboratory of Immunology, Referral Medical Biology Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, 31300 Toulouse, France

²

Toulouse Institute for Infectious and Inflammatory Diseases (INFINITy), INSERM U1291, CNRS U5051, University of Toulouse, 31062 Toulouse, France

³

Department of Internal Medicine, CHU Toulouse, 31059 Toulouse, France

⁴

Department of Infectious Diseases, CHU Toulouse, 31059 Toulouse, France

⁵

Department of Pneumology, CHU Toulouse, 31059 Toulouse, France

⁶

Laboratory of Virology, Institut Fédératif de Biologie, CHU Toulouse, 31300 Toulouse, France

⁷

Department of Neurology, Toulouse University Hospital Center, I2MC-INSERM 1297, 31059 Toulouse, France

^*

Author to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

J. Clin. Med. 2026, 15(11), 4192; https://doi.org/10.3390/jcm15114192

Submission received: 24 March 2026 / Revised: 20 May 2026 / Accepted: 25 May 2026 / Published: 28 May 2026

(This article belongs to the Section Infectious Diseases)

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Abstract

Background/Objectives: This report is an assessment of the characteristics associated with cardiovascular dysautonomia (CVD) in the context of long Coronavirus disease (COVID), which is currently inadequately characterized. Material and Methods: A retrospective cross-sectional study was performed involving 106 patients with long COVID, including 34 individuals diagnosed with CVD, among whom eight met the criteria for Postural Tachycardia Syndrome (PoTS). The variables assessed encompassed individual characteristics (e.g., age, sex, comorbidities), immunization parameters (e.g., vaccination/viral status, timing, frequency), cellular and humoral anti-Spike and anti-Nucleocapsid (Nuc) immune responses, inflammatory and allergic biomarkers, as well as an extensive panel of common autoantibodies comprising anti-nuclear antibodies, anti-central nervous system antibodies (cerebellum, brain), and anti-peripheral nervous system antibodies (gangliosides). Results: An age < 45 years, body mass index, hyperventilation syndrome as well as a higher cumulative number of antigenic contacts (vaccinations plus infections ≥ 3) and an elevated basophil count (≥0.06 G/L) were independently associated with CVD. There was no association between CVD and inflammatory markers or common autoantibodies. Patients with PoTS criteria had a strong anti-Spike cellular immune response and increased IgG anti-Nuc humoral immunity when compared with CVD and non-CVD long COVID counterparts. Conclusions: Compared to other long COVID patients, patients with long COVID-associated CVD have distinctive clinical and immunovirological features. Our results suggest the potential role of the immune response against Spike and of allergic pathways rather than humoral autoimmunity against common autoantibodies in long COVID CVD.

Keywords: long COVID; cardiovascular dysautonomia; Postural Tachycardia Syndrome; age; obesity; anti-viral; inflammation; allergy; autoimmunity

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MDPI and ACS Style

Renaudineau, Y.; Teillaud, S.; Chaves, S.D.A.; Alvarez, M.; Barthes, R.; Bost, C.; Fortenfant, F.; Puissant-Lubrano, B.; Abravanel, F.; Vellas, C.; et al. Clinical and Immunovirological Characteristics Associated with Cardiovascular Dysautonomia in Long COVID. J. Clin. Med. 2026, 15, 4192. https://doi.org/10.3390/jcm15114192

AMA Style

Renaudineau Y, Teillaud S, Chaves SDA, Alvarez M, Barthes R, Bost C, Fortenfant F, Puissant-Lubrano B, Abravanel F, Vellas C, et al. Clinical and Immunovirological Characteristics Associated with Cardiovascular Dysautonomia in Long COVID. Journal of Clinical Medicine. 2026; 15(11):4192. https://doi.org/10.3390/jcm15114192

Chicago/Turabian Style

Renaudineau, Yves, Selena Teillaud, Sébastien De Almeida Chaves, Muriel Alvarez, Romain Barthes, Chloé Bost, Françoise Fortenfant, Bénédicte Puissant-Lubrano, Florence Abravanel, Camille Vellas, and et al. 2026. "Clinical and Immunovirological Characteristics Associated with Cardiovascular Dysautonomia in Long COVID" Journal of Clinical Medicine 15, no. 11: 4192. https://doi.org/10.3390/jcm15114192

APA Style

Renaudineau, Y., Teillaud, S., Chaves, S. D. A., Alvarez, M., Barthes, R., Bost, C., Fortenfant, F., Puissant-Lubrano, B., Abravanel, F., Vellas, C., Pavy-Le Traon, A., & Sailler, L. (2026). Clinical and Immunovirological Characteristics Associated with Cardiovascular Dysautonomia in Long COVID. Journal of Clinical Medicine, 15(11), 4192. https://doi.org/10.3390/jcm15114192

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Clinical and Immunovirological Characteristics Associated with Cardiovascular Dysautonomia in Long COVID

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