Prevalence and clinical significance of relative bradycardia at hospital admission in patients with coronavirus disease 2019 (COVID-19)

Oliva, Alessandra; Franchi, Cristiana; Gatto, Maria Chiara; Galardo, Gioacchino; Pugliese, Francesco; Mastroianni, Claudio Maria

doi:10.1016/j.cmi.2021.04.013

Cited by 14 publications

(21 citation statements)

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“…Vascular inflammation and endothelial activation have been related to the spectrum of COVID-19-associated coagulopathy [5]. Furthermore, among others, the role of sE-selectin as a marker of endothelial dysfunction, inflammation or damage, points out the central role of the endothelium itself not only in the development of a more severe form of the disease, but also in the pathogenesis of the cardiovascular events that occur during COVID-19, including immuno-thrombosis and arrhythmias [6]. As a matter of fact, the inflammatory milieu as a consequence of the so-called 'cytokine storm' may contribute to the progression of endothelial damage, which, in turn, amplifies the pro-inflammatory and pro-coagulant processes [21] as well as the high production of reactive oxygen species [18], all conditions observed during severe COVID-19.…”

Section: Discussionmentioning

confidence: 99%

“…COVID-19 can result in a spectrum of forms ranging from a respiratory tract infection to a systemic and severe form characterized by acute respiratory distress syndrome, shock and thrombotic events [2][3][4]. A great number of these phenomena have been investigated and considerable attention has been paid to the vascular manifestations of the disease [5,6]. Multiple studies have illustrated SARS-CoV-2 to target epithelial cells causing local inflammation leading to an imbalance between anti-coagulant and pro-thrombotic factors [7].…”

Section: Introductionmentioning

confidence: 99%

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Role of Serum E-Selectin as a Biomarker of Infection Severity in Coronavirus Disease 2019

Oliva

Rando

Ismail

et al. 2021

JCM

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Introduction: E-selectin is a recognized marker of endothelial activation; however, its place in Coronavirus Disease 2019 (COVID-19) has not been fully explored. Aims of the study are to compare sE-selectin values among the Intensive Care Unit (ICU)-admitted and non-admitted, survived and non-survived patients and those with or without thrombosis. Methods: A single-center study of patients with COVID-19 hospitalized at Policlinico Umberto I (Rome) from March to May 2020 was performed. Simple and multiple logistic regression models were developed. Results: One hundred patients were included, with a median age (IQR) of 65 years (58–78). Twenty-nine (29%) were admitted to ICU, twenty-eight (28%) died and nineteen (19%) had a thrombotic event. The median value (IQR) of sE-selectin was 26.1 ng/mL (18.1–35). sE-selectin values did not differ between deceased and survivors (p = 0.06) and among patients with or without a thrombotic event (p = 0.22). Compared with patients who did not receive ICU treatments, patients requiring ICU care had higher levels of sE-selectin (36.6 vs. 24.1 ng/mL; p < 0.001). In the multiple logistic regression model, sE-selectin levels > 33 ng/mL, PaO2/FiO2 < 200 and PaO2/FiO2 200–300 were significantly associated with an increased risk of ICU admission. sE-selectin values significantly correlated with a neutrophil count (R = 0.32 (p = 0.001)) and the number of days from the symptoms onset to hospitalization (R = 0.28 (p = 0.004)). Conclusions: sE-selectin levels are predictive of ICU admission in COVID-19 patients. Since data on the relation between sE-selectin and COVID-19 are scarce, this study aims to contribute toward the comprehension of the pathogenic aspects of COVID-19 disease, giving a possible clinical marker able to predict its severity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of Serum E-Selectin as a Biomarker of Infection Severity in Coronavirus Disease 2019

Oliva

Rando

Ismail

et al. 2021

JCM

Self Cite

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“…An unusual feature that is sometimes seen in patients diagnosed with COVID-19 is the appearance of bradycardia, i.e. slow heart rate, or heart rate not increasing as expected with body temperature 11–14 . Amaratunga et al 15 found bradycardia in a study of 4 patients with confirmed COVID-19, with minimum pulse rates in the range 42−49 beats per minute.…”

Section: Introductionmentioning

confidence: 95%

Occurrence of relative bradycardia and relative tachycardia in individuals diagnosed with COVID-19

Natarajan

Heneghan

2022

Preprint

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BackgroundThe COVID-19 disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has become one of the worst global pandemics of the century causing tremendous human and economic suffering worldwide. While considered a respiratory disease, COVID-19 is known to cause cardiac complications. Wearable devices are well equipped to measure heart rate continuously and their popularity makes them valuable devices in the field of digital health. In this article, we use Fitbit devices to examine resting heart rate from individuals diagnosed with COVID-19 aMethodsThe Fitbit COVID-19 survey was conducted from May 2020 - June 2021. We collected resting heart rate data from 7,200 individuals (6,606 symptomatic, 594 asymptomatic) diagnosed with COVID-19 between March 2020 - December 2020, as well as from 463 individuals diagnosed with influenza between January 2020 - December 2020. Data from healthy individuals served as a control, in order to model the seasonal variation. We also computed heart rate variability and respiratory rate data for symptomatic COVID-19.FindingsResting Heart Rate is elevated during COVID-19 symptom onset, with average peak increases relative to the baseline of 1.8%±0.1% (3.4%±0.2%) for females (males), where the quoted numbers are mean and standard error of the mean. After the initial peak, the resting heart rate decreased and reached a minimum on average ≈ 13 days after symptom onset. The minimum value relative to the baseline is more negative for females (−1.75% ± 0.1%) compared to males (0.08% ± 0.2%). The resting heart rate then increased, reaching a second peak on average ≈ 28 days from symptom onset, before falling back to the baseline ≈ 112 days from symptom onset. All estimates vary with disease severity.InterpretationThe resting heart rate is modified for several months following a COVID-19 diagnosis. Interestingly, this effect is seen with seasonal influenza also, although the bradycardia minimum and the second tachycardia peak are often more pronounced in the case of symptomatic COVID-19. By computing resting heart rate daily, wearable devices can contribute to monitoring wellness during recovery from COVID-19, and seasonal influenza.FundingA.N., H.-W.S., and C.H. are supported by Fitbit Research, Google LLC.Research in ContextEvidence before this studyWe searched PubMed, Google, and Google Scholar for research articles published in English up to Oct 31, 2021, using common search terms such as “bradycardia and COVID-19”, “cardiac complications and COVID-19”, etc. Articles were also retrieved by searching through citations of known literature. It is known that COVID-19 can cause cardiac complications such as bradycardia and arrhythmias. Using data from commercially available wearable devices, it has been shown previously that the resting heart is elevated during symptom onset, then decreases reaching a minimum, before rising again to attain a second peak, before finally returning to the baseline.Added value of this studyWe present results from the largest (to our knowledge) dataset considered to-date, involving 7200 participants (6606 symptomatic and 594 asymptomatic) diagnosed with COVID-19. We also present results from 463 individuals diagnosed with influenza. Our large dataset allows us to perform more detailed examinations by age, disease severity, and sex. We also discuss the time evolution of heart rate variability and respiratory rate. The heart rate variability shows a similar time evolution as the resting heart rate but with opposite phase, while the respiratory rate decreases monotonously following the peak at symptom onset.Implications of all the available evidenceThe results presented in this work show that commercially available trackers and smart-watches can help in monitoring heart health in the weeks and months following a COVID-19 diagnosis. An estimate of the amplitude of the bradycardia dip may provide information valuable to critical care.

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“…Cardiac complications are known to be associated with the COVID-19 disease caused by the novel Severe Acute Respiratory Syndrome—Coronavirus 2 (SARS-CoV-2) ( Cizgici et al, 2020 ; Huang et al, 2020 ; Kochi et al, 2020 ; Long et al, 2020 ; Shi et al, 2020 ; Siripanthong et al, 2020 ; Wang et al, 2020 ; Coromilas et al, 2021 ). An unusual feature that is sometimes seen in patients diagnosed with COVID-19 is the appearance of bradycardia, i.e., slow heart rate, or heart rate not increasing as expected with body temperature ( Ikeuchi et al, 2020 ; Capoferri et al, 2021 ; Douedi et al, 2021 ; Oliva et al, 2021 ). Amaratunga et al (2020) found bradycardia in a study of 4 patients with confirmed COVID-19, with minimum pulse rates in the range 42–49 beats per minute.…”

Section: Introductionmentioning

confidence: 96%

Occurrence of Relative Bradycardia and Relative Tachycardia in Individuals Diagnosed With COVID-19

Natarajan

Heneghan

2022

Front. Physiol.

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The COVID-19 disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has become one of the worst global pandemics of the century. Wearable devices are well suited for continuously measuring heart rate. Here we show that the Resting Heart Rate is modified for several weeks following a COVID-19 infection. The Resting Heart Rate shows 3 phases: 1) elevated during symptom onset, with average peak increases relative to the baseline of 1.8% (3.4%) for females (males), 2) decrease thereafter, reaching a minimum on average ≈13 days after symptom onset, and 3) subsequent increase, reaching a second peak on average ≈28 days from symptom onset, before falling back to the baseline ≈112 days from symptom onset. All estimates vary with disease severity1.

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Prevalence and clinical significance of relative bradycardia at hospital admission in patients with coronavirus disease 2019 (COVID-19)

Cited by 14 publications

References 5 publications

Role of Serum E-Selectin as a Biomarker of Infection Severity in Coronavirus Disease 2019

Role of Serum E-Selectin as a Biomarker of Infection Severity in Coronavirus Disease 2019

Occurrence of relative bradycardia and relative tachycardia in individuals diagnosed with COVID-19

Occurrence of Relative Bradycardia and Relative Tachycardia in Individuals Diagnosed With COVID-19

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