Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany.
DRV Clinic Königsfeld, Center for Medical Rehabilitation, Holthauser Talstraße 2, 58256, Ennepetal, Germany.
Sci Rep. 2023 Sep 22;13(1):15814. doi: 10.1038/s41598-023-42615-y.
Post-COVID-19 Syndrome (PCS) is a condition with multiple symptoms partly related to dysregulation of the autonomic nerve system. Assessment of heart rate variability (HRV) using 24 h Holter-ECG may serve as a surrogate to characterize cardiac autonomic activity. A prospective study including 103 PCS patients (time after infection = 252 days, age = 49.0 ± 11.3 years, 45.7% women) was performed and patients underwent detailed clinical screening, cardiopulmonary exercise testing, and 24 h Holter monitoring. Data of PCS patients was compared to 103 CAD patients and a healthy control group (n = 90). After correction for age and sex, frequency-related variables differed in PCS patients compared to controls including LF/HFpower, LF/HFnu, and LF/HF ratio (24 h; p ≤ 0.001). By contrast, these variables were largely comparable between PCS and CAD patients, while sympathetic activation was highest in PCS patients during the 24 h period. Overall, PCS patients showed disturbed diurnal adjustment of HRV, with impaired parasympathetic activity at night. Patients hospitalized during acute infection showed an even more pronounced overactivation of sympathetic activity compared to patients who underwent ambulant care. Our data demonstrate persistent HRV alterations in PCS patients with long-term symptom duration, suggesting a sustained impairment of sympathovagal balance. Moreover, sympathetic overstimulation and diminished parasympathetic response in long-term PCS patients are comparable to findings in CAD patients. Whether HRV variables have a prognostic value in PCS and/or might serve as biomarkers indicating a successful interventional approach warrants further longitudinal studies.
新冠后综合征（PCS）是一种多种症状的疾病，部分与自主神经系统失调有关。使用 24 小时动态心电图（Holter-ECG）评估心率变异性（HRV）可以作为一种替代方法来描述心脏自主活动。进行了一项前瞻性研究，纳入了 103 例 PCS 患者（感染后时间=252 天，年龄=49.0±11.3 岁，45.7%为女性），并对患者进行了详细的临床筛查、心肺运动试验和 24 小时 Holter 监测。将 PCS 患者的数据与 103 例 CAD 患者和健康对照组（n=90）进行比较。校正年龄和性别后，与对照组相比，PCS 患者的频域相关变量存在差异，包括 LF/HF 功率、LF/HFnu 和 LF/HF 比值（24 小时；p≤0.001）。相比之下，这些变量在 PCS 和 CAD 患者之间基本相似，而在 24 小时期间，PCS 患者的交感神经激活最高。总的来说，PCS 患者表现出 HRV 昼夜节律调节紊乱，夜间副交感神经活动受损。与接受门诊治疗的患者相比，急性感染住院的患者表现出更明显的交感神经过度激活。我们的数据表明，长期症状持续的 PCS 患者存在持续的 HRV 改变，提示交感-副交感平衡受损。此外，长期 PCS 患者的交感神经过度刺激和副交感神经反应减弱与 CAD 患者的发现相似。HRV 变量在 PCS 中是否具有预后价值，或者是否可以作为指示干预成功的生物标志物，需要进一步的纵向研究。
