How did coronavirus disease 2019 affect autonomic balance in young individuals? Analysis by heart rate variability

Ceren, İmran; Habip, Fadime Bozduman

doi:10.1590/1806-9282.20231789

Acessibilidade / Reportar erro

Brasil

Revista da Associação Médica Brasileira

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 70 (10) • 2024 • https://doi.org/10.1590/1806-9282.20231789 copy

How did coronavirus disease 2019 affect autonomic balance in young individuals? Analysis by heart rate variability

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE:

The aim of this study was to demonstrate the effect of coronavirus disease 2019 on the cardiovascular autonomic system using heart rate variability in young individuals.

METHODS:

The study was designed retrospectively by scanning the 24-h Holter electrocardiography records of patients who applied to the Ankara Abdurrahman Yurtaslan Oncology Education and Research Hospital Cardiology outpatient clinic. The study group consisted of 492 patients under the age of 40 years, who did not have additional comorbidities or medication use and had prolonged symptoms after coronavirus disease 2019 during the pandemic. The control group, including 401 patients, was determined during the pre-pandemic period (before December 2019). Heart rate variability parameters were evaluated by scanning the 24-h Holter electrocardiography records of the patients and compared with the non-coronavirus disease 2019 group.

RESULTS:

The median age of participants was 30 years. Standard deviation of normal RR intervals (SDNN) ≤100 ms was more prevalent in the study group (27 (6.7%) vs 73 (14.8%), p<0.001). In univariate logistic regression analysis, the presence of coronavirus disease 2019 [(OR 2.41, 95%CI 1.52–3.83), p<0.001] and age [(OR 1.04, 95%CI 1.01–1.07), p=0.016] had a significant effect on the probability of SDNN≤100. In multivariate logistic regression analysis, the presence of coronavirus disease 2019 [(OR 2.42, 95%CI 1.52–3.85), p<0.001] and age [(OR 2.42, 95%CI 1.52–3.85), p=0.016] had a significant effect on the probability of SDNN≤100. Frequency domain measures such as, high-frequency values were significantly higher in the study group (p=0.029). The study group’s low-frequency/high frequency ratio was significantly lower (p=0.019). The low-frequency/high-frequency ratio’s cut-off value was ≤2.77. for determining the differentiation between coronavirus disease 2019 positive and negative cases in the receiver operating characteristic analysis. The sensitivity rate was 80.7%. The area under the curve value is 0.546 (p=0.019).

CONCLUSION:

This study showed that coronavirus disease 2019 causes reduced heart rate variability and increased parasympathetic activity in young patients. This may explain the prolonged symptoms after coronavirus disease 2019 infection.

KEYWORDS:
COVID-19; Autonomic dysfunction; Heart rate determination

	Non-COVID-19 patients (control group) (n=401)	Post-COVID-19 patients (study group) (n=492)	p-value
Age (year)^§ *Mann-Whitney U test;	31.0 [17.0–40.0]	30.0 [18.0–40.0]	0.707^* **Pearson chi-square or Fisher’s exact test;
Sex^‡ ‡n (%);
Female, n (%)	290 (72.3)	331 (67.3)	0.120^ *Independent samples t-test.
Male, n (%)	111 (27.7)	161 (32.7)
Smoking, n (%)	128 (31.9)	174 (35.4)	0.312^ *Independent samples t-test.
SBP, mmHg^§ *Mann-Whitney U test;	120.0 [95.0–135.0]	120.0 [100.0–135.0]	0.262^* **Pearson chi-square or Fisher’s exact test;
DBP, mmHg^§ *Mann-Whitney U test;	73.0 [60.0–85.0]	70.0 [60.0–85.0]	0.127^* **Pearson chi-square or Fisher’s exact test;
Hemoglobin, (g/dL)^§ *Mann-Whitney U test;	13.4 [12.0–15.5]	13.2[12.1–15.3]	0.458^* **Pearson chi-square or Fisher’s exact test;
White blood cells, (cells/μL)^† †Mean ± standard deviation;	7.0 ± 1.4	6.8 ± 1.4	0.121^*** SBP: systolic blood pressure; DBP: diastolic blood pressure.
Thyroid-stimulating hormone, (mIU/L)^§ *Mann-Whitney U test;	1.9 [0.3–4.4]	1.8 [0.4–4.8]	0.187^* **Pearson chi-square or Fisher’s exact test;
Glucose, (mg/dL)^§ *Mann-Whitney U test;	85.0 [63.0–99.0]	85.0 [66.0–98.0]	0.797^* **Pearson chi-square or Fisher’s exact test;
Creatine, (mg/dL)^§ *Mann-Whitney U test;	0.7 [0.5–1.1]	0.7 [0.4–1.0]	0.498^* **Pearson chi-square or Fisher’s exact test;
Left ventricular ejection fraction, %^§ *Mann-Whitney U test;	64.0 [59.0–69.0]	64.0 [60.0–69.0]	0.256^* **Pearson chi-square or Fisher’s exact test;
Left ventricular end-diastolic diameter, mm^§ *Mann-Whitney U test;	43.0 [39.0–44.0]	44.0 [39.0–45.0]	0.259^* **Pearson chi-square or Fisher’s exact test;
Interventricular septum, mm^§ *Mann-Whitney U test;	10.0 [8.0–11.0]	10.0 [9.0–11.0]	0.670^* **Pearson chi-square or Fisher’s exact test;
Posterior wall, mm^§ *Mann-Whitney U test;	9.0 [8.0–11.0]	9.0 [8.0–10.0]	0.522^* **Pearson chi-square or Fisher’s exact test;
Left atrial diameter, mm^§ *Mann-Whitney U test;	33.0 [29.0–36.0]	32.0 [28.0–35.0]	0.658^* **Pearson chi-square or Fisher’s exact test;

	Non-COVID-19 patients (control group) (n=401)	Post-COVID-19 patients (study group) (n=492)	p-value
SDNN, ms^§ §Median [min–max],	145.0 [50.0–372.0]	146.5 [55.0–334.0]	0.960^* *Mann-Whitney U test,
SDNN ≤100^‡ ‡n (%),	27 (6.7)	73 (14.8)	<0.001^ Pearson chi-square or Fisher’s exact test,
RMSSD, ms^§ §Median [min–max],	38.0 [17.0–136.0]	39.0 [17.0–96.0]	0.087^* *Mann-Whitney U test,
PNN50, %^§ §Median [min–max],	14.0 [1.0–44.0]	16.0 [1.0–53.0]	0.067^* *Mann-Whitney U test,
HF, ms2^§ §Median [min–max],	337.0 [45.0–2137.0]	392.0 [24.0–2235.0]	*0.029^ Mann-Whitney U test,*
LF, ms2^§ §Median [min–max],	699.0 [116.0–2161.0]	733.5 [43.0–2307.0]	0.340^* *Mann-Whitney U test,
LF/HF ratio^§ §Median [min–max],	2.0 [0.3–16.4]	1.8 [0.4–33.2]	*0.019^ Mann-Whitney U test,*

Logistic regression predicting “SDNN ≤100”	Univariate logistic regression		Multivariate logistic regression
Logistic regression predicting “SDNN ≤100”	OR. [95%CI]	p-value	OR. [95%CI]	p-value
COVID: positive vs. negative	2.41 [1.52–3.83]	<0.001	2.42 [1.52–3.85]	<0.001
Age	1.04 [1.01–1.07]	0.016	1.04 [1.01–1.07]	0.016
Sex: male vs. female	0.88 [0.55–1.39]	0.571
Smoking: yes vs. no	1.29 [0.84–1.98]	0.246
TSH	1.12 [0.86–1.47]	0.390
WBC	1.08 [0.93–1.25]	0.326
Hemoglobin	0.99 [0.81–1.22]	0.946

Associação Médica Brasileira R. São Carlos do Pinhal, 324, 01333-903 São Paulo SP - Brazil, Tel: +55 11 3178-6800, Fax: +55 11 3178-6816 - São Paulo - SP - Brazil
E-mail: ramb@amb.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] *Corresponding author: drimranceren@gmail.com