Investigation of Autonomic Dysfunction Following COVID-19: the Role of Heart Rate Recovery Indices

Abstract

Aim: COVID-19, caused by SARS-CoV-2, has been linked to longterm complications known as “long COVID,” including autonomic dysfunction. Heart rate recovery (HRR) following exercise is a widely used marker for assessing autonomic function. This study evaluated HRR in Long-Term COVID patients and its association with inflammatory markers. Materials and Methods: This retrospective study included 152 participants: 76 Long-Covid patients and 76 controls. Heart rate recovery was measured at 1, 2, 3, 4, and 5 minutes post-exercise using the Bruce protocol. Baseline demographic data and inflammatory markers, including CRP, D-dimer, and ferritin, were collected. Correlation analysis was performed between HRR and these markers. Results: Long-Covid patients had significantly elevated levels of CRP (14.6±2.3 mg/L vs. 3.3±2.5 mg/L), D-dimer (128.2±42.1 μg/ml vs. 21.1±9.7 μg/ml), and ferritin (277.5±146.8 ng/ml vs. 112.3±78.2 ng/ml) compared to controls (p <0.001). HRR1 and HRR2 were significantly reduced in post-COVID patients (22.4±7.4 vs. 29.0±8.0; 31.5±17.4 vs. 40.2±10.9; p <0.001). Heart rate recovery at 3, 4, and 5 minutes was also markedly lower. A moderate negative correlation was found between HRR2 and CRP (rs=-0.537), D-dimer (rs=-0.459), and ferritin (rs=-0.461) (p <0.001). Conclusion: Long-Covid patients exhibited impaired HRR, indicating autonomic dysfunction, which correlated with elevated inflammatory markers. These findings highlight the importance of HRR as a marker for autonomic imbalance in Long-Covid, suggesting a need for further investigation into therapeutic strategies for autonomic dysfunction.

Keywords

• long COVID
• heart rate recovery (HRR)
• autonomic dysfunction
• inflammatory markers

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