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Autonomic dysfunction and metabolic disorders as the possible sequelae of COVID-19 infection
1Department of Cardiology, Kirikkale Yuksek Ihtisas Hospital, Kirikkale, Turkey. dr.ibrahimhalilinanc@outlook.com.
Insights
COVID-19 infection is linked to long-term autonomic dysfunction, evidenced by higher rates of blunted heart rate recovery (HRR) and exaggerated blood pressure response to exercise (EBPR) in survivors. This suggests an increased cardiovascular event risk post-infection.
Area of Science:
- Cardiology
- Autonomic Nervous System Research
- Infectious Disease Epidemiology
Background:
- COVID-19 is increasingly recognized for its potential long-term sequelae.
- Autonomic dysfunction, affecting involuntary bodily functions, is a suspected complication.
- Limited data exists on the long-term impact of COVID-19 on cardiovascular autonomic function markers like HRR and EBPR.
Purpose of the Study:
- To investigate the long-term association between COVID-19 infection and autonomic dysfunction.
- To evaluate differences in heart rate recovery (HRR) and exaggerated blood pressure response to exercise (EBPR) between COVID-19 survivors and a control group.
- To explore correlations between COVID-19, metabolic parameters, and echocardiographic findings.
Main Methods:
- A cohort study comparing 65 COVID-19 patients with 57 controls.
- Utilized office blood pressure, 24-hour ambulatory blood pressure monitoring, treadmill tests, echocardiography, and metabolic assessments.
- Employed age-adjusted multiple logistic regression for independent association analysis.
Main Results:
- Significantly higher frequencies of blunted HRR (38.5%) and EBPR (10.8%) were observed in the COVID-19 group (p < 0.001 and p = 0.014, respectively).
- COVID-19 survivors exhibited elevated white blood cell, neutrophil, C-reactive protein, and uric acid levels.
- Increased left atrial, aortic root, and ascending aorta diameters were noted in the study group (p < 0.05).
Conclusions:
- Higher prevalence of blunted HRR and EBPR in COVID-19 survivors indicates potential long-term autonomic dysfunction.
- Elevated uric acid levels in the COVID-19 group further support autonomic dysfunction.
- Findings suggest an increased future risk for cardiovascular events among individuals post-COVID-19 infection.
Objective:
The Coronavirus disease 2019 (COVID-19) infection is associated with autonomic dysfunction. Data on the long-term relationship between COVID-19 infection, heart rate recovery (HRR), and exaggerated blood pressure response to exercise (EBPR) are very limited. In our study, we aimed at investigating the long-term association between COVID-19, HRR, EBPR, metabolic, and echocardiographic parameters.
Patients And Methods:
The study included 65 patients in the study group (33 female, median age 46) and 57 in the control group (30 female, 39 median age) between 1 April 2020 and 1 January 2021. Office blood pressure measurement, 24-hour ambulatory blood pressure monitoring, treadmill test, echocardiography, and metabolic parameters were evaluated.
Results:
The frequency of blunted HRR (25 subjects, 38.5%, p < 0.001) and EBPR (7 subjects, 10.8%, p = 0.014) were significantly higher in study group. The study group had higher levels of white blood cell (p = 0.002), neutrophil, c-reactive protein, and uric acid (p < 0.001). Diameters of left atrium, aortic root, and ascending aorta were significantly higher in study group (p < 0.05). Age adjusted multiple logistic regression analysis showed that neutrophil levels (odds ratio (OR), 9.21; 95% confidence interval (CI), 1.52-55.75, p = 0.016), glomerular filtration rate (OR, 1.34; 95% CI, 1.13-1.59, p = 0.001), basal heart rate (OR, 1.58; 95% CI, 1.17-2.12, p = 0.003), and mean heart rate (OR, 1.22; 95% CI, 1.03-1.45, p = 0.0021) were independently associated with COVID-19 infection.
Conclusions:
The frequency of blunted HRR and EBPR, and uric acid levels were significantly higher in the study group compared to the control group, suggesting autonomic dysfunction as the possible sequelae of the COVID-19 infection and increased risk of cardiovascular events in the future.
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