Heart rate variability as a marker of cardiovascular dysautonomia in post-COVID-19 syndrome using artificial intelligence

Abstract

Introduction Cardiovascular dysautonomia comprising postural orthostatic tachycardia syndrome (POTS) and orthostatic hypotension (OH) is one of the presentations in COVID-19 recovered subjects. We aim to determine the prevalence of cardiovascular dysautonomia in post COVID-19 patients and to evaluate an Artificial Intelligence (AI) model to identify time domain heart rate variability (HRV) measures most suitable for short term ECG in these subjects. Methods This observational study enrolled 92 recently COVID-19 recovered subjects who underwent measurement of heart rate and blood pressure response to standing up from supine position and a 12-lead ECG recording for 60 s period during supine paced breathing. Using feature extraction, ECG features including those of HRV (RMSSD and SDNN) were obtained. An AI model was constructed with ShAP AI interpretability to determine time domain HRV features representing post COVID-19 recovered state. In addition, 120 healthy volunteers were enrolled as controls. Results Cardiovascular dysautonomia was present in 15.21% (OH:13.04%; POTS:2.17%) . Patients with OH had significantly lower HRV and higher inflammatory markers. HRV (RMSSD) was significantly lower in post COVID-19 patients compared to healthy controls (13.9 ± 11.8 ms vs 19.9 ± 19.5 ms; P = 0.01) with inverse correlation between HRV and inflammatory markers. Multiple perceptron was best performing AI model with HRV(RMSSD) being the top time domain HRV feature distinguishing between COVID-19 recovered patients and healthy controls. Conclusion Present study showed that cardiovascular dysautonomia is common in COVID-19 recovered subjects with a significantly lower HRV compared to healthy controls. The AI model was able to distinguish between COVID-19 recovered patients and healthy controls.

Long COVID-19 and Postural Orthostatic Tachycardia Syndrome- Is Dysautonomia to Be Blamed?

“…From a cardiovascular point of view, recent papers have highlighted an association between orthostatic intolerance (OI), including orthostatic hypotension (OH) and postural orthostatic tachycardia syndrome (POTS), with long COVID ( 17 – 19 ). OH is defined by a systolic or diastolic blood pressure decrease of 20 mmHg or 10 mHg, respectively, within 3 min of standing and it is the most common autonomic manifestation of long COVID ( 18 , 20 , 21 ). Studies suggest the prevalence of OH with long COVID may range between 10% ( 17 ) up to 41% ( 20 , 21 ).…”

“…OH is defined by a systolic or diastolic blood pressure decrease of 20 mmHg or 10 mHg, respectively, within 3 min of standing and it is the most common autonomic manifestation of long COVID ( 18 , 20 , 21 ). Studies suggest the prevalence of OH with long COVID may range between 10% ( 17 ) up to 41% ( 20 , 21 ). Furthermore, tachycardia has been found to be a common symptom associated with long COVID, with 25–50% of patients in a tertiary post-COVID multidisciplinary team clinic reporting persistent tachycardia or palpitations ( 22 ).…”

Artificial intelligence in cardiology: The past, present and future

“… 21 Recently, ECG based AI model has also found its application in heart rate variability (HRV) monitoring among COVID-19 recovered patients. 22 Furthermore, AI finds a greater deal of application in smart wearable devices such as Apple smartwatch for routine ECG monitoring and arrhythmia detection in the general population. 23 …”

ECG-iCOVIDNet: Interpretable AI model to identify changes in the ECG signals of post-COVID subjects

“…HRV is the measurement of the variability of these N–N intervals. Some recent studies have indicated change in heart rate variability (HRV) in COVID-recovered subjects [ [28] , [29] , [30] ]. This indicates that tracking of the heart status of post-COVID recovered subjects can help in providing timely assistance to these subjects for better survival.…”