Characterization of cardiac autonomic function in COVID-19 using heart rate variability: a hospital based preliminary observational study

Abstract

Objectives The novel corona virus disease, which was initially reported in China in late 2019, has become a global pandemic affecting 330 million cases. COVID-19 affects predominantly the respiratory system, in addition to other organ systems, mainly the cardiovascular system. One of the hypotheses is that virus entering the target cells by binding to angiotensin converting enzyme 2 affecting hypothalamic pituitary axis could lead to dysautonomia which is measured by heart rate variability (HRV). HRV is a non-invasive measure of autonomic function that facilitates identification of COVID-19 patients at the risk of developing cardiovascular complications. So, we aimed to assess HRV in COVID patients and compare between COVID patients and normal controls. Methods In a case control design, we compared 63 COVID-19 infected patients with 43 healthy controls matched for age and gender. Along with clinical characterization, heart rate variability was evaluated using ambulatory 5 min ECG in lead II and expressed in frequency and time domain measures. Statistical analysis was performed using SPSS 17.0. Results Mean age of the study population was 49.1 ± 14.2 years and 71 (66.9%) were males. Frequency domain measures high (HF) and low (LF) frequency powers were significantly decreased in COVID-19 patients compared to controls. HF/LF and LF/HF ratios were not different between groups. Time domain measures rMSSD (root mean square of successive RR interval differences) and SDNN (standard deviation of NN intervals) were significantly increased among COVID-19 subjects. COVID-19 infection was associated with increased parasympathetic activity as defined by rMSSD>40 {adjusted odds ratio 7.609 (95% CI 1.61–35.94); p=0.01} and SDNN>60 {adjusted odds ratio 2.620 (95% CI 1.070–6.44); p=0.035} after adjusting for age, gender and comorbidities. Conclusions Our study results showed increased parasympathetic tone in COVID patients. Early diagnosis of autonomic imbalance in COVID patients is needed to plan management and limit progression of disease.

Evaluation of the renin-angiotensin-aldosterone system and neuroendocrine stress axis in COVID-19 suspicious outpatients tested for SARS-CoV2 RT-PCR referred to 16-hour comprehensive health centers in Abadan County: A cross-sectional case-control study

“…There was no significant difference in terms of age, sex, and mean pulse rate between the two evaluated groups (P ¿0.05). In line with our results, a case-control study comparing the COVID-19 infected patients and healthy matched controls reported that vital parameters like heart rate, systolic, and diastolic blood pressure showed no difference between the study groups (15).…”

“…COVID-19 predominantly affects the respiratory system. It shows a wide range of clinical presentations ranging from asymptomatic/mild symptoms (fever, cough, dyspnea, myalgia, fatigue, anosmia, dysgeusia, and diarrhea) to severe illnesses like acute respiratory distress syndrome (ARDS), arterial and venous thrombosis, myocarditis, and varieties of neurological manifestations (15). COVID-19 can cause shortness of breath, lung damage, and impaired respiratory function.…”

Autonomic dysfunction in SARS-COV-2 infection acute and long-term implications COVID-19 editor’s page series

“…In addition to Tilt Table Testing, Valsalva maneuver, deep breathing test, isometric exercise test and heart rate variability, either in a dedicated laboratory or assessed with a 24-h Holter monitor with appropriate software are mainstays for assessment. Heart rate variability has also been determined in hospitalized patients with COVID-19 using an abbreviated 5-min protocol [ 85 ]. Measurement of plasma catecholamines may be useful (reviewed in Guaraldi) [ 86 ].…”

How COVID‐19 can cause autonomic dysfunctions and postural orthostatic syndrome? A Review of mechanisms and evidence

“…According to research, COVID‐19 has an effect on the autonomic nervous system; so that concepts such as the extended autonomous system (EAS), allostasis, and dyshomeostasis may reflect COVID‐19's age‐related mortality and the involvement of several organ sites in the disease 23 . One study found that COVID‐19 patients had increased parasympathetic activity and autonomic imbalance despite key factors such as age, gender, and comorbidities like diabetes mellitus 24 . COVID‐19 and the autonomic system have a complicated relationship.…”