Assessment of Autonomic Nervous System Dysfunction in the Early Phase of Infection With SARS-CoV-2 Virus - PubMed (original) (raw)

Assessment of Autonomic Nervous System Dysfunction in the Early Phase of Infection With SARS-CoV-2 Virus

Branislav Milovanovic et al. Front Neurosci. 2021.

Abstract

Background: We are facing the outburst of coronavirus disease 2019 (COVID-19) defined as a serious, multisystem, disorder, including various neurological manifestations in its presentation. So far, autonomic dysfunction (AD) has not been reported in patients with COVID-19 infection.

Aim: Assessment of AD in the early phase of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus).

Patients and methods: We analyzed 116 PCR positive COVID-19 patients. After the exclusion of 41 patients with associate diseases (CADG), partitioned to patients with diabetes mellitus, hypertension, and syncope, the remaining patients were included into a severe group (45 patients with confirmed interstitial pneumonia) and mild group (30 patients). Basic cardiovascular autonomic reflex tests (CART) were performed, followed by beat-to-beat heart rate variability (HRV) and systolic and diastolic blood pressure variability (BPV) analysis, along with baroreceptor sensitivity (BRS). Non-linear analysis of HRV was provided by Poincare Plot. Results were compared to 77 sex and age-matched controls.

Results: AD (sympathetic, parasympathetic, or both) in our study has been revealed in 51.5% of severe, 78.0% of mild COVID-19 patients, and the difference compared to healthy controls was significant (p = 0.018). Orthostatic hypotension has been established in 33.0% COVID-19 patients compared to 2.6% controls (p = 0.001). Most of the spectral parameters of HRV and BPV confirmed AD, most prominent in the severe COVID-19 group. BRS was significantly lower in all patients (severe, mild, CADG), indicating significant sudden cardiac death risk.

Conclusion: Cardiovascular autonomic neuropathy should be taken into account in COVID-19 patients' assessment. It can be an explanation for a variety of registered manifestations, enabling a comprehensive diagnostic approach and further treatment.

Keywords: COVID-19; autonomic nervous system; autonomic neuropathy; cardiovascular reflex test; heart rate variability.

Copyright © 2021 Milovanovic, Djajic, Bajic, Djokovic, Krajnovic, Jovanovic, Verhaz, Kovacevic and Ostojic.

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Conflict of interest statement

SJ was employed by the company Telekom Srbija a.d. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1

FIGURE 1

Orthostatic hypotension in COVID-19. Results for COVID-19 patients are given in respect to both severe and mild group.

FIGURE 2

FIGURE 2

Heart rate and characteristic blood pressure variability in rest and during orthostatic hypotension and head up tilt test by patient with COVID-19 infection and low baroreflex sensitivity (real time beat to beat blood pressure analysis).

FIGURE 3

FIGURE 3

Poincare plots and corresponding heart rate signals: (A) Healthy volunteer; (B) COVID-19 patient; (C) COVID-19 patient. Note that the scale is the same in all graphs. The plots are included to illustrate the adverse effects of COVID-19 infection, but the signals were not part of the presented statistics. Patient (b) is male, 71 years old, height 168, weight 66. The patient reported no hereditary diseases, gait instability, and last 2 months the patient was experiencing hard breathing. During hospitalization it was discovered that the patient has heart valve disease, before that the patient was healthy. Patient (c) is female, 87 years old, height 163, weight 81. She reported problems with spine, occasional headaches, dizziness when changing her head position, no hereditary diseases and no other health problems.

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