Investigating the possible mechanisms of autonomic dysfunction post-COVID-19

Jammoul, Maya; Naddour, Judith; Madi, Amir; Reslan, Mohammad Amine; Hatoum, Firas; Zeineddine, Jana; Abou-Kheir, Wassim; Lawand, Nada

doi:10.1016/j.autneu.2022.103071

Cited by 34 publications

(28 citation statements)

References 156 publications

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“…This finding suggests that it may be premature to draw consensus conclusions about changes in ANS in the context of COVID-19. A recent review suggested that potential mechanisms of ANS dysfunction after COVID-19 may involve direct invasion of SARS-CoV-2 through neuronal or hematogenous routes, autoimmunity, persistent inflammation, hypoxia, and renin-angiotensin system imbalance [ 53 ]. In the context of the diverse mechanisms, whether ANS plays a pivotal role in post-COVID-19 conditions, including long COVID, remains to be elucidated, and the findings in this review provide only fragmented information.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Impact of COVID-19 on Heart Rate Variability: A Systematic Review of Observational Studies

2023

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Coronavirus disease 2019 (COVID-19) sequelae (or long COVID) has become a clinically significant concern. Several studies have reported the relationship between heart rate variability (HRV) parameters and COVID-19. This review investigates the long-term association between COVID-19 and HRV parameters. Four electronic databases were searched up to 29 July 2022. We included observational studies comparing HRV parameters (measurement durations: 1 min or more) in participants with and without a history of COVID-19. We used assessment tools developed by the National Heart, Lung, and Blood Institute group to evaluate the methodological quality of included studies. Eleven cross-sectional studies compared HRV parameters in individuals who recovered from acute COVID-19 infection to controls (n = 2197). Most studies reported standard deviation of normal-to-normal intervals (SDNN) and root mean square of the successive differences. The methodological quality of the included studies was not optimal. The included studies generally found decreased SDNN and parasympathetic activity in post-COVID-19 individuals. Compared to controls, decreases in SDNN were observed in individuals who recovered from COVID-19 or had long COVID. Most of the included studies emphasized parasympathetic inhibition in post-COVID-19 conditions. Due to the methodological limitations of measuring HRV parameters, the findings should be further validated by robust prospective longitudinal studies.

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Section: Discussionmentioning

confidence: 99%

Long-Term Impact of COVID-19 on Heart Rate Variability: A Systematic Review of Observational Studies

2023

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“…Several recent articles have highlighted CVOs 43,44 . There are several areas within the brain that abut ventricles and have no blood brain barrier.…”

Section: Cvosmentioning

confidence: 99%

Long Covid, POTS, and ME/CFS: Lifting the Fog

Chambers¹

2023

Preprint

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These three syndromes - long covid (LC), postural orthostatic tachycardia syndrome (POTS), and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) - have many symptoms in common. The common denominator remains elusive. The blood brain barrier (BBB) has been a barrier not only to microbes and toxins but also to understanding pathogenetic links. There are several areas within the brain that have no BBB. These are known as circumventricular organs (CVOs) and their location relative to CNS nuclei that direct autonomic and neuroendocrine functions is provocative in the quest for pathogenesis. In addition the majority afflicted with LC and ME/CFS appear to be those with two MTHFR polymorphisms, present in over 50% of Americans. These polymorphisms elevate homocysteine. When homocysteine is combined with CVOs, the fog of POTS and its paradox are lifted. POTS may represent the intersection of LC and ME/CFS in those with the MTHFR gene (hypermethylation or 677TT). The gut microbiomes of LC and ME/CFS, deficient in butyrates, GABA, and diversity, are then linked with MTHFR genotype 677TT. Reactivation of neurotropic EBV and VZV, due to loss of surveillance by CD4+/CD8+ T cells, is seen as secondary. The oxidative stress generated by homocysteine, loss of glutathione, low fiber diet, and persistent chronic inflammation exhaust available mitochondria and, assisted by BKN and estrogen, exacerbate all the elements of these post viral fatigue syndromes.

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“…IST is defined by a sinus heart rate inexplicably higher than one hundred beats per minute (bpm) at rest that is associated with symptoms like palpitations, dyspnea or dizziness in the absence of primary causes of tachycardia 6,7 . Potential causes of IST include: sympathovagal imbalance, beta‐adrenergic receptor hypersensitivity, and brain stem dysregulation leading to the hypoactivity of the parasympathetic tone; however its pathogenesis is not fully understood 8,9 …”

Section: Introductionmentioning

confidence: 99%

“…6,7 Potential causes of IST include: sympathovagal imbalance, beta-adrenergic receptor hypersensitivity, and brain stem dysregulation leading to the hypoactivity of the parasympathetic tone; however its pathogenesis is not fully understood. 8,9 The aim of the present study was to perform a thorough clinical characterization of patients with IST to identify potential risk factors for this arrhythmia in individuals with PCS.…”

mentioning

confidence: 99%

Triglicerydes/high‐density lipoprotein ratio as a risk factor of post‐Covid‐19 sinus tachycardia: A retrospective study

Kuryłowicz,

Babicki,

Wąsowski

et al. 2024

Journal of Medical Virology

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Inappropriate sinus tachycardia (IST) is one of the manifestations of the post‐COVID‐19 syndrome (PCS), which pathogenesis remains largely unknown. This study aimed to identify potential risk factors for IST in individuals with PCS. The 1349 patients with PCS were included into the study. Clinical examination, 24H Holter ECG, 24H ambulatory blood pressure monitoring and biochemical tests were performed 12–16 weeks after the COVID‐19 in all participants. IST was found in 69 (3.5%) individuals. In the clinical assessment IST patients were characterized by a higher age (p < 0.001) and lower prevalence of the diagnosed hypertension (p = 0.012), compared to remaining patients. Biochemical testing showed higher serum triglycerides (1.66 vs. 1.31 pmol/L, p = 0.007) and higher prevalence of a low high‐density lipoprotein (HDL) cholesterol (24.6% vs. 15.2%, p = 0.035) in the IST group. Subsequently, the triglicerydes (TG)/HDL ratio, an indicator of insulin resistance, was significantly higher in the IST individuals (3.2 vs. 2.4, p = 0.005). 24H monitoring revealed a significantly higher minimum diastolic, maximum systolic and mean arterial blood pressure values in the IST group (p < 0.001 for all), suggesting a high prevalence of undiagnosed hypertension. A multivariate analysis confirmed the predictive value TG/HDL ratio >3 (OR 2.67, p < 0.001) as predictors of IST development. A receiver operating characteristic curve analysis of the relationship between the TG/HDL ratio and the IST risk showed that the predictive cut‐off point for this parameter was 2.46 (area under the ROC curve = 0.600, p = 0.004). Based on these findings, one can conclude that insulin resistance seems to be a risk factor of IST, a common component of PCS.

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Investigating the possible mechanisms of autonomic dysfunction post-COVID-19

Cited by 34 publications

References 156 publications

Long-Term Impact of COVID-19 on Heart Rate Variability: A Systematic Review of Observational Studies

Long-Term Impact of COVID-19 on Heart Rate Variability: A Systematic Review of Observational Studies

Long Covid, POTS, and ME/CFS: Lifting the Fog

Triglicerydes/high‐density lipoprotein ratio as a risk factor of post‐Covid‐19 sinus tachycardia: A retrospective study

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