Post-Acute Effect of SARS-CoV-2 Infection on the Cardiac Autonomic Function

Abstract

Background Recent studies reported a long-lasting effect of COVID-19 infection that extends beyond the active disease and disrupts various body systems besides the respiratory system. The current study aims to investigate the post-acute effect of SARS-CoV-2 infection on cardiovascular autonomic activity, reactivity and sensitivity in patients who had the infection at least 3 months before. Methods This was a comparative cross-sectional observational study. Fifty-nine subjects were allocated into two groups, controls (n=31), who had no history of positive COVID-19 infection, and the post-COVID patients (n=28) who were recruited 3 to 8 months after testing positive for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR). Baseline cardiovascular autonomic activity was evaluated through recording of baseline heart rate variability (HRV), autonomic reactivity was determined through standard cardiovascular autonomic reflex tests (CART), and cardiac autonomic sensitivity was assessed through cardiac baroreceptor sensitivity (cBRS). Results Higher incidence of orthostatic hypotension was observed in post-COVID patients compared to controls (39.3% and 3.2%, respectively, p <0.001). Additionally, significantly reduced handgrip test, and heart rate response to head-up tilt was illustrated in the post-COVID group (p <0.001). About 85.7% of post-COVID participants had at least one abnormal cardiovascular reflex test (CART) compared to the control group (p <0.001). Although HRV parameters (TP, LF, HF, SDRR, RMSSD, pRR50), and the cBRS were numerically lower in the post-COVID-19 group, this did not reach the level of significance. Conclusion The results of the present study are suggestive of altered cardiovascular reactivity in post-acute COVID patients and demand further investigation and longer term follow up.

Investigating Autonomic Nervous System Dysfunction among Patients with Post- Covid Condition and Prolonged Cardiovascular Symptoms

“…Taken together, these ndings indicate a normal sympathetic modulation of the heart within 6 months in patients with PCS. These ndings are in line with the observations from Salem et al 23 , who investigated the post-acute effect of SARSCoV-2 infection on cardiovascular autonomic activity, reactivity, and sensitivity, in patients who had the infection at least 3 months before. These authors observed that these patients displayed several parameters of HRV without signi cant changes.…”

“…Asarcikli et al 4 have also found an LF/HF ratio increase, which is consistent with sympathetic overactivity. On the other hand, when Salem et al 23 investigated the post-acute effect of SARSCoV-2 infection on cardiovascular autonomic activity in patients with PCS, who were exposed to the infection at least 3 months before, they concluded that despite several parameters of HRV being numerically reduced in these patients with PCS, they were not statistically signi cant.…”

Alterações e sequelas cardiovasculares desencadeadas pela COVID-19: Revisão da literatura

“…Dentre os danos cardíacos e vasculares encontrados em pacientes pós COVID-19, destacam-se: isquemia miocárdica, infarto, miocardite e arritmias cardíacas. (Salem et al, 2022). Os sintomas cardiovasculares mais comuns são: dor no peito, palpitação, taquicardia e intolerância ortostática (Yong, 2021).…”

Cardiac autonomic function in post-COVID-19 patients and its impact on haemodynamics during neurosurgery – A prospective observational study

“…One reason could be a longer duration between HRV assessment and COVID-19 infection, as noted in an earlier study. [ 10 ] Another reason could be the non-severe nature of previous COVID-19 infections.…”