da Silva Fernanda Stábile, Bonifácio Lívia Pimenta, Bellissimo-Rodrigues Fernando, Joaquim Luis Fernando, Martins Dias Daniel Penteado, Dias Romano Minna Moreira, Schmidt André, Crescêncio Júlio César, Buzinari Tereza C, Fazan Rubens, Salgado Helio Cesar
Department of Physiology, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.
Front Med (Lausanne). 2023 Oct 9;10:1216452. doi: 10.3389/fmed.2023.1216452. eCollection 2023.
Heart Rate Variability (HRV) and arterial pressure (AP) variability and their responses to head-up tilt test (HUTT) were investigated in Post-COVID-19 syndrome (PCS) patients reporting tachycardia and/or postural hypotension. Besides tachycardia, PCS patients also showed attenuation of the following HRV parameters: RMSSD [square root of the mean of the sum of the squares of differences between adjacent normal-to-normal (NN) intervals] from statistical measures; the power of RR (beat-to-beat interval) spectra at HF (high frequency) from the linear method spectral analysis; occurrence of 2UV (two unlike variation) pattern of RR from the nonlinear method symbolic analysis; and the new family of statistics named sample entropy, when compared to control subjects. Basal AP and LF (low frequency) power of systolic AP were similar between PCS patients and control subjects, while 0 V (zero variation) patterns of AP from the nonlinear method symbolic analysis were exacerbated in PCS patients. Despite tachycardia and a decrease in RMSSD, no parameter of HRV changed during HUTT in PCS patients compared to control subjects. PCS patients reassessed after 6 months showed higher HF power of RR spectra and a higher percentage of 2UV pattern of RR. Moreover, the reassessed PCS patients showed a lower occurrence of 0 V patterns of AP, while the HUTT elicited HR (heart rate) and AP responses identical to control subjects. The HRV and AP variability suggest an autonomic dysfunction with sympathetic predominance in PCS patients. In contrast, the lack of responses of HRV and AP variability indices during HUTT indicates a marked impairment of autonomic control. Of note, the reassessment of PCS patients showed that the noxious effect of COVID-19 on autonomic control tended to fade over time.
在报告有心动过速和/或体位性低血压的新冠后综合征（PCS）患者中，研究了心率变异性（HRV）、动脉压（AP）变异性及其对直立倾斜试验（HUTT）的反应。除心动过速外，PCS患者还表现出以下HRV参数的衰减：从统计测量来看，相邻正常到正常（NN）间期差值平方和均值的平方根（RMSSD）；从线性方法频谱分析来看，RR（逐搏间期）频谱在高频（HF）处的功率；从非线性方法符号分析来看，RR的2UV（两种不同变异）模式的出现；以及与对照组相比，名为样本熵的新统计量家族。PCS患者和对照组之间的基础AP以及收缩期AP的低频（LF）功率相似，而从非线性方法符号分析来看，PCS患者AP的0V（零变异）模式加剧。尽管存在心动过速且RMSSD降低，但与对照组相比，PCS患者在HUTT期间HRV的任何参数均未发生变化。6个月后重新评估的PCS患者显示RR频谱的HF功率更高，RR的2UV模式百分比更高。此外，重新评估的PCS患者AP的0V模式出现率更低，而HUTT引起的心率（HR）和AP反应与对照组相同。HRV和AP变异性表明PCS患者存在以交感神经为主导的自主神经功能障碍。相比之下，HUTT期间HRV和AP变异性指标缺乏反应表明自主神经控制存在明显损害。值得注意的是，PCS患者的重新评估表明，新冠病毒对自主神经控制的有害影响倾向于随时间消退。
