Investigating Autonomic Nervous System Dysfunction among Patients with Post- Covid Condition and Prolonged Cardiovascular Symptoms

Fernanda Stábile da Silva; Lívia Pimenta Bonifácio; Fernando Bellissimo‐Rodrigues; Luiz Fernando Joaquim; Daniel Penteado Martins Dias; Minna Moreira Dias Romano; André Schmidt; Júlio César Crescêncio; Tereza Cristina Buzinari; Rubens Fazan; Hélio César Salgado

doi:10.21203/rs.3.rs-2500721/v1

February 1, 2023Open Access

Investigating Autonomic Nervous System Dysfunction among Patients with Post- Covid Condition and Prolonged Cardiovascular Symptoms

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Why the study?

Does post-Covid-19 syndrome cause autonomic nervous system dysfunction as measured by heart rate and blood pressure variability at rest and during orthostatic stress?

Key Points

To investigate heart rate and arterial pressure variability, alongside head-up tilt test cardiovascular responses, in post-COVID-19 syndrome patients presenting with prolonged tachycardia and postural hypotension.
Evaluated resting heart rate (HR) and arterial pressure (AP) variability using spectral, symbolic, and entropy analyses in post-COVID-19 syndrome (PCS) patients and control subjects.
Assessed autonomic reflex responses during a head-up tilt test (HUTT) at baseline.
Reassessed autonomic indices and HUTT responses in PCS patients after a 6-month follow-up period.
PCS patients exhibited resting tachycardia, reduced RMSSD, lower high-frequency RR spectral power, fewer 2UV patterns, lower sample entropy, and increased 0V patterns of AP compared to controls.
During initial HUTT, PCS patients showed blunted autonomic control with no significant changes in HR or AP variability indices despite persistent tachycardia.
At 6-month reassessment, PCS patients demonstrated increased high-frequency RR power, normalized 0V and 2UV patterns, and HUTT-evoked HR and AP responses identical to controls.

Structured PICO

Does post-Covid-19 syndrome cause autonomic nervous system dysfunction as measured by heart rate and blood pressure variability at rest and during orthostatic stress?

P

Population

38 adults, comprising 16 patients (median age 45, 56% female) with post-Covid-19 syndrome (PCS) experiencing prolonged cardiovascular symptoms (tachycardia, postural hypotension) 6 to 12 months after infection requiring hospitalization, and 22 healthy control subjects (median age 52, 68% female) evaluated before the Covid-19 pandemic.

I

Intervention

Post-Covid-19 syndrome (PCS) exposure, evaluated at rest and during head-up tilt test (HUTT), with a subset of 10 patients reassessed after approximately 6 months.

C

Comparator

Healthy control subjects evaluated before the Covid-19 pandemic who displayed normal responses to the head-up tilt test (HUTT).

O

Outcome

Heart rate (HR) and arterial pressure (AP) variability at rest and in response to head-up tilt test (HUTT), measured via time domain (RMSSD), frequency domain (LF and HF power), symbolic analysis, and sample entropy.surrogate

Patients with post-Covid-19 syndrome and cardiovascular symptoms demonstrate significant autonomic dysfunction characterized by sympathetic predominance and impaired responses to orthostatic stress, which may partially resolve over time.

Implication

Autonomic impairment in PCS should not yet change practice; leaves open prospective trials on recovery and interventions.

Abstract

The variability of heart rate (HR) and arterial pressure (AP), and their responses to head-up tilt test (HUTT) was investigated in post-Covid-19 syndrome (PCS) patients, reporting tachycardia and/or postural hypotension. PCS patients were tachycardic and showed attenuation of the following parameters: RMSSD; power of RR spectra at HF; occurrence of 2UV pattern of RR (symbolic analysis); and sample entropy. Basal AP and LF power of systolic AP were similar between PCS patients and control subjects; while 0V patterns of AP were exacerbated in PCS patients. Despite tachycardia and decrease in RMSSD, no parameter changed during HUTT in PCS patients. PCS patients reassessed after 6 months showed higher HF power of RR spectra and higher percentage of 2UV pattern of RR. Moreover, the reassessed PCS patients showed a lower occurrence of 0V patterns of AP, while the HUTT elicited HR and AP responses identical to control subjects. The HR and AP variability suggest an autonomic dysfunction with sympathetic predominance in PCS patients; while the lack of responses of HR and BP variability indices during HUTT indicates a marked impairment of autonomic control. However, the reassessment of PCS patients showed that the noxious effect of the PCS tended to fade over time.

Discussion

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Cite This Study

Silva et al. (2023) studied this question.

synapsesocial.com/papers/6a81d897080e7f4ac74d7d0a https://doi.org/10.21203/rs.3.rs-2500721/v1

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Investigating Autonomic Nervous System Dysfunction among Patients with Post- Covid Condition and Prolonged Cardiovascular Symptoms

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

Investigating Autonomic Nervous System Dysfunction among Patients with Post- Covid Condition and Prolonged Cardiovascular Symptoms

Key Points

Structured PICO

Implication

Abstract

Discussion

Cite This Study

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