Abstract:BACKGROUND: Coronavirus disease 2019 (COVID-19) can damage cardiac tissue by increasing troponin levels and inducing arrhythmias, myocarditis, and acute coronary syndrome. OBJECTIVES: To analyze the impact of COVID-19 on cardiac autonomic control in mechanically ventilated intensive care unit (ICU) patients. DESIGN AND SETTING: This cross-sectional analytical study of ICU patients of both sexes receiving mechanical ventilation was conducted in a tertiary hospital. METHODS: Patients were divided into COVID-19-p… Show more
“…We suggest that SURVs within the COVID-19 group might have more powerful internal regulatory resources to limit the progress of inflammation, prevent exaggerated immune responses and avoid the development of arrhythmic events [1,8,11,12,22,49,51]. The more limited activity of the cardiac arm of the baroreflex might contribute to the worse prognosis associated with small HP variations in critically ill COVID-19 patients [1,7,8,19,20].…”
Section: Association Of Baroreflex Control Markers Of Non-covid-19 An...mentioning
confidence: 92%
“…Modifications of the autonomic control and baroreflex function following COVID-19 infection have often been studied via the analysis of spontaneous changes in heart period (HP) and systolic arterial pressure (SAP) [17,18]. Remarkably, it was found that the magnitude of HP changes holds prognostic value in critically ill COVID-19 patients [1,7,8,19,20]. Lower values of HP variability were associated with the severity of COVID-19 [19], while higher values were a distinctive feature of surviving COVID-19 patients admitted to the ICU [1].…”
Section: Introductionmentioning
confidence: 99%
“…Lower values of HP variability were associated with the severity of COVID-19 [19], while higher values were a distinctive feature of surviving COVID-19 patients admitted to the ICU [1]. Moreover, smaller changes in HP were reported to precede the increase in inflammatory markers [7], to predict ICU indication and admission in the first week after hospitalization [8] and to characterize patients who received mechanical ventilation [20]. Survivors of mild COVID-19 at 3-6 months exhibited an impaired baroreflex response that might explain the incidence of postural hypotensive episodes in post-COVID-19 patients [17].…”
Background: Autonomic function and baroreflex control might influence the survival rate of coronavirus disease 2019 (COVID-19) patients admitted to the intensive care unit (ICU) compared to respiratory failure patients without COVID-19 (non-COVID-19). This study describes physiological control mechanisms in critically ill COVID-19 patients admitted to the ICU in comparison to non-COVID-19 individuals with the aim of improving stratification of mortality risk. Methods: We evaluated autonomic and baroreflex control markers extracted from heart period (HP) and systolic arterial pressure (SAP) variability acquired at rest in the supine position (REST) and during a modified head-up tilt (MHUT) in 17 COVID-19 patients (age: 63 ± 10 years, 14 men) and 33 non-COVID-19 patients (age: 60 ± 12 years, 23 men) during their ICU stays. Patients were categorized as survivors (SURVs) or non-survivors (non-SURVs). Results: We found that COVID-19 and non-COVID-19 populations exhibited similar vagal and sympathetic control markers; however, non-COVID-19 individuals featured a smaller baroreflex sensitivity and an unexpected reduction in the HP-SAP association during the MHUT compared to the COVID-19 group. Nevertheless, none of the markers of the autonomic and baroreflex functions could distinguish SURVs from non-SURVs in either population. Conclusions: We concluded that COVID-19 patients exhibited a more preserved baroreflex control compared to non-COVID-19 individuals, even though this information is ineffective in stratifying mortality risk.
“…We suggest that SURVs within the COVID-19 group might have more powerful internal regulatory resources to limit the progress of inflammation, prevent exaggerated immune responses and avoid the development of arrhythmic events [1,8,11,12,22,49,51]. The more limited activity of the cardiac arm of the baroreflex might contribute to the worse prognosis associated with small HP variations in critically ill COVID-19 patients [1,7,8,19,20].…”
Section: Association Of Baroreflex Control Markers Of Non-covid-19 An...mentioning
confidence: 92%
“…Modifications of the autonomic control and baroreflex function following COVID-19 infection have often been studied via the analysis of spontaneous changes in heart period (HP) and systolic arterial pressure (SAP) [17,18]. Remarkably, it was found that the magnitude of HP changes holds prognostic value in critically ill COVID-19 patients [1,7,8,19,20]. Lower values of HP variability were associated with the severity of COVID-19 [19], while higher values were a distinctive feature of surviving COVID-19 patients admitted to the ICU [1].…”
Section: Introductionmentioning
confidence: 99%
“…Lower values of HP variability were associated with the severity of COVID-19 [19], while higher values were a distinctive feature of surviving COVID-19 patients admitted to the ICU [1]. Moreover, smaller changes in HP were reported to precede the increase in inflammatory markers [7], to predict ICU indication and admission in the first week after hospitalization [8] and to characterize patients who received mechanical ventilation [20]. Survivors of mild COVID-19 at 3-6 months exhibited an impaired baroreflex response that might explain the incidence of postural hypotensive episodes in post-COVID-19 patients [17].…”
Background: Autonomic function and baroreflex control might influence the survival rate of coronavirus disease 2019 (COVID-19) patients admitted to the intensive care unit (ICU) compared to respiratory failure patients without COVID-19 (non-COVID-19). This study describes physiological control mechanisms in critically ill COVID-19 patients admitted to the ICU in comparison to non-COVID-19 individuals with the aim of improving stratification of mortality risk. Methods: We evaluated autonomic and baroreflex control markers extracted from heart period (HP) and systolic arterial pressure (SAP) variability acquired at rest in the supine position (REST) and during a modified head-up tilt (MHUT) in 17 COVID-19 patients (age: 63 ± 10 years, 14 men) and 33 non-COVID-19 patients (age: 60 ± 12 years, 23 men) during their ICU stays. Patients were categorized as survivors (SURVs) or non-survivors (non-SURVs). Results: We found that COVID-19 and non-COVID-19 populations exhibited similar vagal and sympathetic control markers; however, non-COVID-19 individuals featured a smaller baroreflex sensitivity and an unexpected reduction in the HP-SAP association during the MHUT compared to the COVID-19 group. Nevertheless, none of the markers of the autonomic and baroreflex functions could distinguish SURVs from non-SURVs in either population. Conclusions: We concluded that COVID-19 patients exhibited a more preserved baroreflex control compared to non-COVID-19 individuals, even though this information is ineffective in stratifying mortality risk.
Introduction: Following an infection with SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), many individuals fully recover. On the other hand, a few have symptoms that last for weeks, months, or even years after their initial diagnosis. Symptoms of COVID-19 persisting for four weeks and more are termed long COVID.Aim: To assess the long-term cardiovascular morbidity by battery of cardiac autonomic function tests as well as the persistence of inflammation in COVID-recovered patients three months after initial infection.Methodology: 150 patients were selected who had recovered from COVID-19 at least three months prior to the study. After obtaining informed written consent, a throat swab was tested for COVID-19, and those with negative reverse transcription polymerase chain reaction (RT-PCR) results were subjected to autonomic function testing. Serum interleukin-6 and C-reactive protein levels were determined by enzyme-linked immunosorbent assay (ELISA) test.Results: Out of 150 subjects 36 were found to have autonomic dysfunction graded according to Ewing's criteria. Individuals with autonomic dysfunction also had significantly increased inflammatory biomarker levels. There was also significant correlation between inflammatory markers and autonomic function test and heart rate variability parameters.
Conclusion:Even years after the COVID-19 pandemic was declared, new symptom patterns and syndromes such as 'long COVID' are appearing. A better understanding of the pathophysiological mechanisms of post-COVID manifestations that affect the autonomic nervous system, as well as customized therapeutic care, should help reduce COVID-19 sequelae, particularly if we act early in the disease.
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