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Characterization of cardiac autonomic function in COVID-19 using heart rate variability: a hospital based preliminary
Deepalakshmi Kaliyaperumal1, Karthikeyan Rk2, Murali Alagesan3
1Physiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India.
Insights
COVID-19 patients exhibit increased parasympathetic activity, indicated by heart rate variability (HRV) measures. This finding suggests potential autonomic imbalance, crucial for managing cardiovascular risks in COVID-19 survivors.
Area of Science:
- Cardiology
- Infectious Diseases
- Autonomic Neuroscience
Background:
- COVID-19, a global pandemic, primarily affects the respiratory and cardiovascular systems.
- Autonomic dysfunction, potentially linked to the virus's interaction with the ACE2 receptor and the hypothalamic-pituitary axis, is hypothesized in COVID-19.
- Heart rate variability (HRV) serves as a non-invasive indicator of autonomic nervous system function and cardiovascular risk.
Purpose of the Study:
- To investigate heart rate variability (HRV) in patients diagnosed with COVID-19.
- To compare HRV parameters between COVID-19 patients and a healthy control group.
- To assess potential autonomic nervous system imbalances in individuals with COVID-19.
Main Methods:
- A case-control study comparing 63 COVID-19 patients with 43 age- and gender-matched healthy controls.
- Ambulatory 5-minute ECG recordings (Lead II) were used to evaluate heart rate variability.
- Analysis included both frequency-domain (HF, LF) and time-domain (rMSSD, SDNN) measures of HRV.
Main Results:
- COVID-19 patients showed significantly decreased high-frequency (HF) and low-frequency (LF) powers compared to controls.
- Time-domain measures, including rMSSD and SDNN, were significantly increased in COVID-19 patients.
- Increased parasympathetic activity was associated with COVID-19 infection (rMSSD > 40 and SDNN > 60), even after adjusting for covariates.
Conclusions:
- The study findings indicate an elevated parasympathetic tone in COVID-19 patients.
- Early detection of autonomic imbalance in COVID-19 is essential for effective management and mitigating disease progression.
- HRV assessment can aid in identifying COVID-19 patients at risk for cardiovascular complications.
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.
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