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Impaired Vagal Activity in Long-COVID-19 Patients

Domenico Acanfora1, Maria Nolano2,3, Chiara Acanfora1,4

  • 1Department of Internal Medicine, San Francesco Hospital, Viale Europa 21, 82037 Telese Terme, Italy.

Viruses
|May 28, 2022
PubMed

Insights

Long COVID-19 patients exhibit autonomic nervous system dysfunction, indicated by altered heart rate variability. This dysautonomia, linked to elevated D-dimer and NT-ProBNP, may explain persistent symptoms and requires monitoring.

Area of Science:

  • Cardiology
  • Neurology
  • Infectious Diseases

Background:

  • Long COVID-19, characterized by persistent symptoms post-acute infection, is associated with increased risks of multiorgan dysfunction, readmission, and mortality.
  • Biomarkers such as D-Dimer and NT-ProBNP, along with autonomic nervous system dysfunction, are frequently observed in Long COVID-19 patients.
  • The hypothesis of dysautonomia contributing to Long COVID-19 symptoms warrants further investigation.

Purpose of the Study:

  • To investigate the presence and extent of dysautonomia in Long COVID-19 patients.
  • To analyze heart rate variability (HRV) using 12-lead 24-h ECG monitoring in Long COVID-19 patients compared to a control group.
  • To identify correlations between HRV parameters, specific biomarkers, and Long COVID-19 status.

Main Methods:

  • Recruitment of 30 Long COVID-19 patients and 20 control subjects with no history of COVID-19.
  • Utilized 12-lead 24-h electrocardiogram (ECG) monitoring for comprehensive heart rate variability assessment.
  • Employed power spectral analysis to evaluate HRV components (Total Power, VLF, HF) and the LF/HF ratio.

Main Results:

  • Long COVID-19 patients demonstrated significantly lower total power (p < 0.0001) and HF component (p = 0.015) of HRV.
  • A significantly higher LF/HF ratio (p = 0.001) was observed in Long COVID-19 patients, indicating sympathetic-vagal imbalance.
  • Multivariable analysis revealed significant correlations between Long COVID-19 and D-dimer (β=0.259), NT-ProBNP (β=0.281), HF component (β=0.696), and LF/HF ratio (β=0.820).

Conclusions:

  • Dysautonomia, specifically impaired vagal activity, is a significant finding in Long COVID-19 patients.
  • Persistent procoagulative state (elevated D-dimer) and myocardial strain (elevated NT-ProBNP) may contribute to vagal impairment.
  • Careful monitoring and intervention are crucial for Long COVID-19 patients due to impaired vagal activity, elevated NT-ProBNP, and a prothrombotic state.

Keywords:
D-dimerLong-COVID-19NT-ProBNPdysautonomia hypothesisheart rate variabilityprocoagulative state

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