Reduction of Cardiac Autonomic Modulation and Increased Sympathetic Activity by Heart Rate Variability in Patients With Long COVID

Marques, Karina Carvalho; Silva, Camilla Costa; Trindade, Steffany da Silva; Santos, Márcio Clementino de Souza; Rocha, Rodrigo Santiago Barbosa; Vasconcelos, Pedro Fernando da Costa; Quaresma, Juarez Antônio Simões; Falcão, Luiz Fábio Magno

doi:10.3389/fcvm.2022.862001

Cited by 45 publications

(38 citation statements)

References 35 publications

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“… 45 Furthermore, a study by Marques et al revealed a reduction in HRV with increased sympathetic modulation, and a decrease in parasympathetic modulation in long COVID. 46 Cardiac autonomic dysfunction has also been reported during the early stage of COVID-19 diseases. Milovanovic et al showed sympathetic dysfunction with orthostatic hypotension in about 46.3%, and abnormal handgrip tests in about 94.4% of post-COVID patients.…”

Section: Discussionmentioning

confidence: 98%

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

Salem¹,

Yar²,

Eid³

et al. 2022

IJGM

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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.

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Section: Discussionmentioning

confidence: 98%

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

Salem¹,

Yar²,

Eid³

et al. 2022

IJGM

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“…Using longer-duration wearable sensor data, Radin et al showed that subjects with COVID-19 exhibited transient bradycardia followed by a prolonged tachycardia, which did not return to baseline until 79 days on average after the symptom onset [ 101 ]. It has been reported that patients with long COVID showed increased sympathetic activity and parasympathetic reduction [ 102 ]. Recently, Mills et al demonstrated that bromodomain and extra-terminal protein (BET) family inhibitors prevented diastolic dysfunction and death in a mouse cytokine-storm model via reduction of SARS-CoV-2 infection of cardiomyocytes by decreasing ACE2 expression [ 103 ].…”

Section: Mechanisms For Long Covid and Cardiovascular Damagementioning

confidence: 99%

Long COVID and hypertension-related disorders: a report from the Japanese Society of Hypertension Project Team on COVID-19

et al. 2022

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s The coronavirus disease 2019 (COVID-19) affects infected patients even after the acute phase and impairs their health and quality of life by causing a wide variety of symptoms, referred to as long COVID. Although the evidence is still insufficient, hypertension is suspected to be a potential risk factor for long COVID, and the occurrence of cardiovascular diseases seems to be a key facet of multiple conditions observed in long COVID. Nonetheless, there are few reports that comprehensively review the impacts of long COVID on hypertension and related disorders. As a sequel to our previous report in 2020 which reviewed the association of COVID-19 and hypertension, we summarize the possible influences of long COVID on hypertension-related organs, including the cardiovascular system, kidney, and endocrine system, as well as the pathophysiological mechanisms associated with the disorders in this review. Given that the clinical course of COVID-19 is highly affected by age and sex, we also review the impacts of these factors on long COVID. Lastly, we discuss areas of uncertainty and future directions, which may lead to better understanding and improved prognosis of clinical problems associated with COVID-19.

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“…In order to provide evidence in favor of the dysautonomia hypothesis, we investigated heart rate variability (HRV) in both the time and frequency domains by performing a non-invasive study of sympathetic and parasympathetic activity in long COVID-19 patients. HRV [31][32][33][34][35] is a legitimate dysautonomia diagnosis. It is possible that HRV may be a useful tool for examining the neuroimmune systems and inflammatory processes of long COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

Cardiac Autonomic Function in Long COVID-19 Using Heart Rate Variability: An Observational Cross-Sectional Study

Menezes¹,

Schröeder²,

Botelho³

et al. 2022

Preprint

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Background: Heart rate variability is a non-invasive, measurable, and established autonomic nervous system test. Long-term COVID-19 sequelae are unclear; however, acute symptoms have been studied. Objectives: To determine autonomic cardiac differences between long COVID-19 patients and heathy controls and evaluate associations among symptoms, comorbidities, and laboratory findings. Methods: This single-center study included long COVID-19 patients and healthy controls. The heart rate variability (HRV), a quantitative marker of autonomic activity, was monitored for 24 h using an ambulatory electrocardiogram system. HRV indices were compared between case and control groups. Symptom frequency and inflammatory markers were evaluated. The significance level of 5% (p-value 0.05) was adopted. Results: A total of 47 long COVID-19 patients were compared to 42 healthy controls. Patients averaged 43.8 (SD14.8) years old, and 60.3% were female. In total, 52.5% of patients had moderate illness. Post-exercise dyspnea was most common (71.6%), and 53.2% lacked comorbidities. COVID-19 patients had 4 times more dyslipidemia. CNP, D-dimer, and CRP levels were elevated (p-values of 0.0098, 0.0023, and 0.0015, respectively). The control group had greater SDNN24 and SDANNI (OR = 0.98 (0.97 to 0.99; p = 0.01)). Increased low-frequency (LF) indices in COVID-19 patients (OR = 1.002 (1.0001 to 1.004; p = 0.030)) and high-frequency (HF) indices in the control group (OR = 0.987 (0.98 to 0.995; p = 0.001)) were also associated. Conclusions: Patients with long COVID-19 had lower HF values than healthy individuals. These variations are associated with increased parasympathetic activity, which may be related to long COVID-19 symptoms and inflammatory laboratory findings.

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Reduction of Cardiac Autonomic Modulation and Increased Sympathetic Activity by Heart Rate Variability in Patients With Long COVID

Cited by 45 publications

References 35 publications

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

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

Long COVID and hypertension-related disorders: a report from the Japanese Society of Hypertension Project Team on COVID-19

Cardiac Autonomic Function in Long COVID-19 Using Heart Rate Variability: An Observational Cross-Sectional Study

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