Heart Rate Variability in Hospitalized Patients with Suspected or Confirmed Diagnosis of COVID-19: A Retrospective Analysis in Comparison to Healthy Controls and in Relation to Proinflammatory Cytokines

Abstract

Objective: This study was designed to evaluate heart rate variability (HRV) in hospitalized patients with suspected or confirmed diagnosis of coronavirus disease-2019 (COVID-19) in comparison to healthy controls and in relation to proinflammatory cytokines. Materials and Methods: A total of 115 subjects consisting of 3 subgroups (53 patients with confirmed diagnosis of COVID-19, 42 patients with suspected diagnosis of COVID-19 and 20 healthy controls) were included in this study. Data on patient demographics, inflammatory markers (C-reactive protein [CRP], D-Dimer, ferritin, procalcitonin) and the 24-h Holter monitoring parameters were recorded. Results: None of the Holter monitoring parameters differed significantly between patients with suspected COVID-19 and those with confirmed COVID-19. In both suspected COVID-19 and confirmed COVID-19 groups, standard deviation of all NN intervals (SDNN, p<0.001 for each) and HRV triangular index (p<0.001 for each) values were significantly lower than the values in the control group, while the root mean square of differences between successive NN intervals (RMSSD, p<0.001 for each), low frequency (LF, p=0.001 and p<0.001, respectively), high frequency (HF, p<0.001 for each) and LF/HF ratio (p<0.001 for each) values were significantly higher than the values in the control group. Procalcitonin and SDNN values (r=0.227, p=0.044) were positively correlated. Conclusion: Our findings revealed significant changes in both time-domain and frequency-domain parameters of HRV in COVID-19 patients, regardless of the viral load, in favor of autonomic nervous system dysfunction. Accordingly, our findings indicate the potential utility of HRV as a valuable clinical tool to monitor autonomic dysfunction in COVID-19 patients resulting from the underlying inflammatory process or the treatment side effects, aiding clinicians in early prediction of a cytokine storm, and in the triage, disease progress monitoring and treatment.

Keywords

• COVID-19
• heart rate variability
• time domain indices
• frequency-domain indices
• suspected diagnosis
• confirmed diagnosis
• proinflammatory cytokines
• COVID-19, heart rate variability, time domain indices, frequency-domain indices, suspected diagnosis, confirmed diagnosis, proinflammatory cytokines

COVID-19 şüpheli veya kesin tanısı ile yatışı yapılan hastalarda kalp hızı değişkenliği: Sağlıklı kontrollere göre ve proinflamatuvar sitokinler açısından bir retrospektif analiz

Abstract

Giriş ve Amaç: Bu çalışma, Koronavirüs hastalığı-2019 (COVID-19) şüpheli veya kesin tanısı ile yatışı yapılan hastalarda kalp hızı değişkenliğinin (KHD) sağlıklı kontrollerle kıyaslanması ve proinflamatuvar sitokinler bağlamında değerlendirilmesi amacı ile tasarlandı. Gereç ve Yöntemler: Bu çalışmaya, 3 alt gruptan oluşan (53 kesin COVID-19 tanısı almış hasta, 42 şüpheli COVID-19 tanısı almış hasta ve 20 sağlıklı kontrol) toplam 115 denek dahil edildi. Hasta demografik özellikleri, inflamatuvar belirteçler (C-reaktif protein [CRP], D-Dimer, ferritin ve prokalsitonin) ve 24-saat Holter monitorizasyon parametrelerine ait veriler kaydedildi. Bulgular: Holter monitorizayonu parametrelerinin hiçbiri, şüpheli ve kesin COVID-19 tanısına sahip gruplar arasında anlamlı fark göstermedi. Şüpheli ve kesin COVID-19 tanılı her iki grupta, bütün NN intervallerinin standart sapması (SDNN, her biri için p<0,001) ve KHD triangular indeksi (her biri için p<0,001) değerleri kontrol grubu değerlerine göre anlamlı olarak daha düşük iken, ardışık normal NN intervalleri arasındaki farkların karekökü (RMSSD, her biri için p<0,001), düşük frekans (LF, sırasıyla p=0,001 ve p<0.001), yüksek frekans (HF, her biri için p<0,001) ve LF/HF oranı (her biri için p<0,001) değerleri kontrol grubu değerlerine göre anlamlı olarak daha yüksek bulundu. Prokalsitonin ve SDNN değerleri arasında pozitif korelasyon mevcuttu (r=0,227, p=0,044). Sonuç: Bulgularımız COVID-19 hastalarında KHD’nin hem zaman-bağımlı hem de frekans-bağımlı parametreler açısından önemli değişimler gösterdiğine ve bu değişimin viral yükten bağımsız olup, otonom sinir sistemi disfonksiyonu lehine olduğuna işaret etmektedir. Dolayısıyla bulgularımız, KHD’nin COVID-19 hastalarında altta yatan inflamatuvar sürece veya tedavi yan etkilerine bağlı gelişen otonom disfonksiyonun değerlendirilmesi açısından kullanışlı bir klinik araç olarak sitokin fırtınasının erken tahmini, tiraj, hastalık progresyonunun izlenmesi ve tedavi bakımından klinisyenlere yol gösterebileceği yönündedir.

Keywords

• COVID-19; kalp hızı değişkenliği
• zaman-bağımlı indeksler
• frekans-bağımlı indeksler şüpheli tanı; kesin tanı; proinflamatuvar sitokinler

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