Autonomic Nervous System Activity for Risk Stratification of Emergency Patients With Pneumonia

Mizera, Lars; Boehm, Katharina; Duckheim, Martin; Groga‐Bada, Patrick; Gawaz, Meinrad; Zuern, Christine S.; Eick, Christian

doi:10.1016/j.jemermed.2018.06.016

Cited by 8 publications

(6 citation statements)

References 29 publications

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“…Concerning other HRV parameters, contrasting results were found regarding their prognostic role in acute COVID-19 patients, except for the DC, whose reduction was associated with a poor prognosis [37,42]. These results confirm the evidence of previous studies, which report that a reduction in SDNN and DC is associated with a poor prognosis in several medical conditions [105][106][107][108][109], including pneumonia from other causes [110] or sepsis [111].…”

Section: Discussionsupporting

confidence: 77%

Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review

Scala

Rizzo

Bellavia

et al. 2022

JCM

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Although autonomic dysfunction (AD) after the recovery from Coronavirus disease 2019 (COVID-19) has been thoroughly described, few data are available regarding the involvement of the autonomic nervous system (ANS) during the acute phase of SARS-CoV-2 infection. The primary aim of this review was to summarize current knowledge regarding the AD occurring during acute COVID-19. Secondarily, we aimed to clarify the prognostic value of ANS involvement and the role of autonomic parameters in predicting SARS-CoV-2 infection. According to the PRISMA guidelines, we performed a systematic review across Scopus and PubMed databases, resulting in 1585 records. The records check and the analysis of included reports’ references allowed us to include 22 articles. The studies were widely heterogeneous for study population, dysautonomia assessment, and COVID-19 severity. Heart rate variability was the tool most frequently chosen to analyze autonomic parameters, followed by automated pupillometry. Most studies found ANS involvement during acute COVID-19, and AD was often related to a worse outcome. Further studies are needed to clarify the role of autonomic parameters in predicting SARS-CoV-2 infection. The evidence emerging from this review suggests that a complex autonomic nervous system imbalance is a prominent feature of acute COVID-19, often leading to a poor prognosis.

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Section: Discussionsupporting

confidence: 77%

Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review

Scala

Rizzo

Bellavia

et al. 2022

JCM

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“…In a previous study, the prognostic value of DC was demonstrated in emergency patients with pneumonia. 11 …”

Section: Discussionmentioning

confidence: 99%

“… 6 DC has already been proved to be a powerful predictor of mortality in persons with myocardial infarction, heart failure, cancer, aortic stenosis, syncope, stroke and pneumonia. 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 Recently, a retrospective, observational case series emphasized direct and indirect affection of the central nervous system in COVID-19 persons with respiratory insufficiency. 14 In the current study, we postulate that impaired DC provides prognostic information in persons with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Deceleration capacity is associated with acute respiratory distress syndrome in COVID-19

et al. 2021

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Background : Acute respiratory distress syndrome (ARDS) is considered the main cause of COVID-19 associated morbidity and mortality. Early and reliable risk stratification is of crucial clinical importance in order to identify persons at risk for developing a severe course of disease. Deceleration capacity (DC) of heart rate as a marker of cardiac autonomic function predicts outcome in persons with myocardial infarction and heart failure. We hypothesized that reduced modulation of heart rate may be helpful in identifying persons with COVID-19 at risk for developing ARDS. Methods : We prospectively enrolled 60 consecutive COVID-19 positive persons presenting at the University Hospital of Tuebingen. Arterial blood gas analysis and 24h-Holter ECG recordings were performed and analyzed at admission. The primary end point was defined as development of ARDS with regards to the Berlin classification. Results : 61.7% (37 of 60 persons) developed an ARDS. In persons with ARDS DC was significantly reduced when compared to persons with milder course of infection (3.2 ms vs. 6.6 ms, p < 0.001). DC achieved a good discrimination performance (AUC = 0.76) for ARDS in COVID-19 persons. In a multivariate analysis, decreased DC was associated with the development of ARDS. Conclusion : Our data suggest a promising role of DC to risk stratification in COVID-19.

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“…This parameter provides indirect insight into the balance of the autonomic nervous system and can be determined noninvasively and objectively by heart rate variability analysis. Autonomic impairment and reduced DC are already established as markers of cardiovascular risk and outcome 10–13 …”

Section: Introductionmentioning

confidence: 99%

“…Autonomic impairment and reduced DC are already established as markers of cardiovascular risk and outcome. [10][11][12][13] This study aimed to evaluate the prognostic value of DC on mortality in patients with severe MR undergoing TEER.…”

Section: Introductionmentioning

confidence: 99%

Deceleration capacity of heart rate predicts 1‐year mortality in patients undergoing transcatheter edge‐to‐edge mitral valve repair

Mizera

Rath

Schreieck

et al. 2023

Clinical Cardiology

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Background Risk stratification for transcatheter procedures in patients with severe mitral regurgitation is challenging. Deceleration capacity (DC) has already proven to be a reliable risk predictor in patients undergoing transcatheter aortic valve implantation. We hypothesized, that DC provides prognostic value in patients undergoing transcatheter edge‐to‐edge mitral valve repair (TEER). Methods We retrospectively analyzed electrocardiogram signals from 106 patients undergoing TEER at the University Hospital of Tübingen. All patients received continuous heart‐rate monitoring to assess DC following the procedure. One‐year all‐cause mortality was defined as the primary end point. Results Sixteen patients (15.1%) died within 1 year. The DC in nonsurvivors was significantly reduced compared to survivors (5.1 ± 3.0 vs. 3.0 ± 1.6 ms, p = 0.002). A higher EuroSCORE II and impaired left ventricular function were furthermore associated with poor outcome. In Cox regression analyses, a DC < 4.5 ms was found a strong predictor of 1‐year mortality (hazard ratio: 0.10, 95% confidence interval: 0.13–0.79, p = 0.029). Finally, a significant negative correlation was found between DC and residual mitral regurgitation after TEER (r = −0.41, p < 0.001). Conclusion In patients with severe mitral regurgitation undergoing TEER, DC may serve as a new predictor of follow‐up mortality.

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Autonomic Nervous System Activity for Risk Stratification of Emergency Patients With Pneumonia

Cited by 8 publications

References 29 publications

Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review

Autonomic Dysfunction during Acute SARS-CoV-2 Infection: A Systematic Review

Deceleration capacity is associated with acute respiratory distress syndrome in COVID-19

Deceleration capacity of heart rate predicts 1‐year mortality in patients undergoing transcatheter edge‐to‐edge mitral valve repair

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