Gruionu Gabriel, Aktaruzzaman Md, Gupta Anita, Nowak Thomas V, Ward Matthew, Everett Thomas H
Krannert Cardiovascular Research Center, Division of Cardiovascular Medicine, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Division of Gastroenterology-Hepatology, Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, IN, USA.
Sci Rep. 2024 Dec 28;14(1):30774. doi: 10.1038/s41598-024-80918-w.
COVID-19 is associated with long-term cardiovascular complications. Heart Rate Variability (HRV), a measure of sympathetic (SNS) and parasympathetic (PNS) control, has been shown to predict COVID-19 outcomes and correlate with disease progression but a comprehensive analysis that includes demographic influences has been lacking. The objective of this study was to determine the balance between SNS, PNS and heart rhythm regulation in hospitalized COVID-19 patients and compare it with similar measurements in healthy volunteers and individuals with cardiovascular diseases (CVD), while also investigating the effects of age, Body Mass Index (BMI), gender and race. Lead I ECG recordings were acquired from 50 COVID-19 patients, 31 healthy volunteers, and 51 individuals with cardiovascular diseases (CVD) without COVID-19. Fourteen HRV parameters were calculated, including time-domain, frequency-domain, nonlinear, and regularity metrics. The study population included a balanced demographic profile, with 55% of participants being under 65 years of age, 54% identifying as male, and 68% identifying as White. Among the COVID-19 patients, 52% had a BMI ≥ 30 compared to 29% of healthy volunteers and 33% of CVD patients. COVID-19 and CVD patients exhibited significantly reduced time-domain HRV parameters, including SDNN and RMSSD, compared to healthy volunteers (SDNN: 0.02 ± 0.02 s vs. 0.06 ± 0.03 s, p < 0.001; RMSSD: 0.02 ± 0.02 s vs. 0.05 ± 0.03 s, p = 0.08). In the frequency domain, both COVID-19 and CVD patients showed increased low-frequency (LF) power and lower high-frequency (HF) power compared to healthy volunteers (COVID-19 LF: 18.47 ± 18.18%, HF: 13.69 ± 25.80%; Healthy LF: 23.30 ± 11.79%, HF: 22.91 ± 21.86%, p < 0.01). The LF/HF ratio was similar in COVID-19 patients (1.038 ± 1.54) and healthy volunteers (1.03 ± 0.78). Nonlinear parameters such as SD1 were significantly lower in COVID-19 patients (0.04 ± 0.04 s vs. 0.08 ± 0.05 s, p < 0.01), indicating altered autonomic regulation. Variations in HRV were observed based on demographic factors, with younger patients, females, and non-white individuals showing more pronounced autonomic dysfunction. COVID-19 patients exhibit significant alterations in HRV, indicating autonomic dysfunction, characterized by decreased vagal tone and sympathetic dominance, similar to patients with severe cardiovascular comorbidities. Despite higher heart rates, the HRV analysis suggests COVID-19 is associated with substantial disruption in autonomic regulation, particularly in patients with specific demographic risk factors.
新冠病毒病（COVID-19）与长期心血管并发症相关。心率变异性（HRV）是一种衡量交感神经（SNS）和副交感神经（PNS）控制的指标，已被证明可预测COVID-19的预后并与疾病进展相关，但缺乏一项包括人口统计学影响的全面分析。本研究的目的是确定住院COVID-19患者中SNS、PNS和心律调节之间的平衡，并将其与健康志愿者和心血管疾病（CVD）患者的类似测量结果进行比较，同时还研究年龄、体重指数（BMI）、性别和种族的影响。从50名COVID-19患者、31名健康志愿者和51名无COVID-19的心血管疾病（CVD）患者中采集I导联心电图记录。计算了14个HRV参数，包括时域、频域、非线性和规律性指标。研究人群的人口统计学特征均衡，55%的参与者年龄在65岁以下，54%为男性，68%为白人。在COVID-19患者中，52%的人体重指数（BMI）≥30，而健康志愿者和CVD患者的这一比例分别为29%和33%。与健康志愿者相比，COVID-19患者和CVD患者的时域HRV参数，包括标准差（SDNN）和连续RR间期差值的均方根（RMSSD）显著降低（SDNN：0.02±0.02秒对0.06±0.03秒，p<0.001；RMSSD：0.02±0.02秒对0.05±0.03秒，p=0.08）。在频域中，与健康志愿者相比，COVID-19患者和CVD患者的低频（LF）功率增加，高频（HF）功率降低（COVID-19患者LF：18.47±18.18%，HF：13.69±25.80%；健康志愿者LF：23.30±11.79%，HF：22.91±21.86%，p<0.01）。COVID-19患者的LF/HF比值（1.038±1.54）与健康志愿者（1.03±0.78）相似。COVID-19患者的非线性参数如SD1显著降低（0.04±0.04秒对0.08±0.05秒，p<0.01），表明自主神经调节改变。基于人口统计学因素观察到HRV的变化，年轻患者、女性和非白人个体表现出更明显的自主神经功能障碍。COVID-19患者的HRV表现出显著改变，表明存在自主神经功能障碍，其特征为迷走神经张力降低和交感神经占优势，类似于患有严重心血管合并症的患者。尽管心率较高，但HRV分析表明COVID-19与自主神经调节的实质性破坏相关，特别是在具有特定人口统计学风险因素的患者中。
