Evaluation of Outpatients in the Post-COVID-19 Period in Terms of Autonomic Dysfunction and Silent Ischemia

Abstract

Introduction and objective: In this context, the objective of this study is to evaluate the 24-hour ambulatory electrocardiography (ECG) recordings, autonomous function with heart rate variability (HRV), and silent ischemia (SI) attacks with ST depression burden (SDB) and ST depression time (SDT) of post-COVID-19 patients.Materials and methods: The 24-hour ambulatory ECG recordings obtained >12 weeks after the diagnosis of COVID-19 were compared between 55 consecutive asymptomatic and 73 symptomatic post-COVID-19 patients who applied to the cardiology outpatient clinic with complaints of palpitation and chest pain in comparison with asymptomatic post-COVID-19 patients in Kars Harakani state hospital. SDB, SDT, and HRV parameters were analyzed. Patients who had been on medication that might affect HRV, had comorbidities that might have caused coronary ischemia, and were hospitalized with severe COVID-19 were excluded from the study.Results: There was no significant difference between symptomatic and asymptomatic post-COVID-19 patients in autonomic function. On the other hand, SDB and SDT parameters were significantly higher in symptomatic post-COVID-19 patients than in asymptomatic post-COVID-19 patients. Multivariate analysis indicated that creatine kinase-myoglobin binding (CK-MB) (OR:1.382, 95% CI:1.043-1.831; p=0.024) and HRV index (OR: 1.033, 95% CI:1.005-1.061; p=0.019) were found as independent predictors of palpitation and chest pain symptoms in post-COVID-19 patients. Conclusion:The findings of this study revealed that parasympathetic overtone and increased HRV were significantly higher in symptomatic patients with a history of COVID-19 compared to asymptomatic patients with a history of COVID-19 in the post-COVID-19 period. Additionally, 24-hour ambulatory ECG recordings and ST depression analysis data indicated that patients who experienced chest pain in the post-COVID-19 period experienced silent ischemia (SI) attacks.

Analysis of heart rate variability in post-COVID-19 population

“…We observed that few studies have compared recovered post-COVID populations and long-COVID patients, an aspect that our study addresses. A decrease in PNS activity (HRV parameters decreased) [22][23][24][25][26] or PNS overtones (HRV parameters increased) 20,27 in individuals with a history of COVID-19 compared to healthy individuals was previously investigated; however, they focused on the elderly or patients with severe forms of COVID-19. In this study, we reported no difference in measures of HRV in adults who had a history of SARS-CoV-2 infection compared to healthy individuals, which may be due to the fact that the majority of the sample were young adults, in line with the studies of Skow et al 28 , Buchhorn et al 29 , Freire et al 30 and López-Galán et al 31 .…”

Cardiovascular Autonomic Nervous System in a Patient With Hereditary Angioedema Affected by COVID-19

“…Symptoms such as smell and taste loss, focal neurological signs, fatigue, and lightheadedness are reported in more than one-third of patients and can be attributed to the central and autonomic nervous system (ANS) during both the acute and recovery phases characterizing the so-called post-COVID-19 syndrome [1]. Among them, orthostatic hypotension and intolerance, postural orthostatic tachycardia syndrome, and heart rate variability (HRV) impairment are commonly observed [1,2]. A recent systematic review [1] also demonstrated the involvement of the ANS at the cardiovascular level as a predictor of the prognosis during and after COVID-19 infection.…”

Association of New-Onset Atrial Fibrillation With All-Cause Mortality in COVID-19 Patients

“…It is known that COVID-19 may cause cardiac involvement at macrovascular and microvascular levels [6]. Numerous cardiovascular complications have been identified in the context of COVID-19, including myocarditis, ST-elevation myocardial infarction (STEMI), arrhythmias, vascular endothelial dysfunction, thromboembolism, coronary vasospasm, and cardiomyopathy, all of which exhibit a strong association with adverse clinical outcomes [6][7][8]. The incidence of these complications exhibits substantial heterogeneity across different study populations, with arrhythmia emerging as the second most prevalent complication following acute respiratory distress syndrome (ARDS) [9].…”