Reduction of Cardiac Autonomic Modulation and Increased Sympathetic Activity by Heart Rate Variability in Patients With Long COVID

Karina Carvalho Marques; Camilla Costa Silva; Steffany da Silva Trindade; Márcio Clementino de Souza Santos; Rodrigo Santiago Barbosa Rocha; Pedro Fernando da Costa Vasconcelos; Juarez Antônio Simões Quaresma; Luiz Fábio Magno Falcão

doi:10.3389/fcvm.2022.862001

Reduction of Cardiac Autonomic Modulation and Increased Sympathetic Activity by Heart Rate Variability in Patients With Long COVID

Front Cardiovasc Med. 2022 Apr 29:9:862001. doi: 10.3389/fcvm.2022.862001. eCollection 2022.

Authors

Karina Carvalho Marques¹, Camilla Costa Silva¹, Steffany da Silva Trindade², Márcio Clementino de Souza Santos³, Rodrigo Santiago Barbosa Rocha⁴, Pedro Fernando da Costa Vasconcelos¹, Juarez Antônio Simões Quaresma¹, Luiz Fábio Magno Falcão¹

Affiliations

¹ Postgraduate Program in Parasitic Biology in the Amazon, Laboratory of Infectious and Cardiopulmonary Diseases, Long COVID Program, Centre for Biological and Health Sciences, Pará State University, Belém, Brazil.
² Laboratory of Infectious and Cardiopulmonary Diseases, Long COVID Program, Centre for Biological and Health Sciences, Pará State University, Belém, Brazil.
³ Department of Human Movement Sciences, Centre for Biological and Health Sciences, Pará State University, Belém, Brazil.
⁴ Centre for Biological and Health Sciences, Pará State University, Belém, Brazil.

Abstract

Although several clinical manifestations of persistent long coronavirus disease (COVID-19) have been documented, their effects on the cardiovascular and autonomic nervous system over the long term remain unclear. Thus, we examined the presence of alterations in cardiac autonomic functioning in individuals with long-term manifestations. The study was conducted from October 2020 to May 2021, and an autonomic assessment was performed to collect heart rate data for the heart rate variability (HRV) analysis. The study participants were divided into the long COVID clinical group, the intragroup, which included patients who were hospitalized, and those who were not hospitalized and were symptomatic for different periods (≤3, >3, ≤6, and >6 months), with and without dyspnoea. The control group, the intergroup, comprised of COVID-free individuals. Our results demonstrated that the long COVID clinical group showed reduced HRV compared with the COVID-19-uninfected control group. Patients aged 23-59 years developed COVID symptoms within 30 days after infection, whose diagnosis was confirmed by serologic or reverse-transcription polymerase chain reaction (swab) tests, were included in the study. A total of 155 patients with long COVID [95 women (61.29%), mean age 43.88 ± 10.88 years and 60 men (38.71%), mean age 43.93 ± 10.11 years] and 94 controls [61 women (64.89%), mean age 40.83 ± 6.31 and 33 men (35.11%), mean age 40.69 ± 6.35 years] were included. The intragroup and intergroup comparisons revealed a reduction in global HRV, increased sympathetic modulation influence, and a decrease in parasympathetic modulation in long COVID. The intragroup showed normal sympathovagal balance, while the intergroup showed reduced sympathovagal balance. Our findings indicate that long COVID leads to sympathetic excitation influence and parasympathetic reduction. The excitation can increase the heart rate and blood pressure and predispose to cardiovascular complications. Short-term HRV analysis showed good reproducibility to verify the cardiac autonomic involvement.

Keywords: autonomic nervous system; coronavirus infection; heart rate; heart rate variability; long COVID.