Assessment of Autonomic Nervous System Dysfunction in the Early Phase of Infection With SARS-CoV-2 Virus.

Branislav Milovanovic,Miodrag Ostojic,Tatjana Krajnovic,Antonija Verhaz,Pedja Kovacevic,Aleksandra Djokovic,Dragana Bajic,Vlado Djajic,Sladjana Jovanovic

doi:10.3389/fnins.2021.640835

Abstract

BackgroundWe are facing the outburst of coronavirus disease 2019 (COVID-19) defined as a serious, multisystem, disorder, including various neurological manifestations in its presentation. So far, autonomic dysfunction (AD) has not been reported in patients with COVID-19 infection.AimAssessment of AD in the early phase of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus).Patients and methodsWe analyzed 116 PCR positive COVID-19 patients. After the exclusion of 41 patients with associate diseases (CADG), partitioned to patients with diabetes mellitus, hypertension, and syncope, the remaining patients were included into a severe group (45 patients with confirmed interstitial pneumonia) and mild group (30 patients). Basic cardiovascular autonomic reflex tests (CART) were performed, followed by beat-to-beat heart rate variability (HRV) and systolic and diastolic blood pressure variability (BPV) analysis, along with baroreceptor sensitivity (BRS). Non-linear analysis of HRV was provided by Poincare Plot. Results were compared to 77 sex and age-matched controls.ResultsAD (sympathetic, parasympathetic, or both) in our study has been revealed in 51.5% of severe, 78.0% of mild COVID-19 patients, and the difference compared to healthy controls was significant (p = 0.018). Orthostatic hypotension has been established in 33.0% COVID-19 patients compared to 2.6% controls (p = 0.001). Most of the spectral parameters of HRV and BPV confirmed AD, most prominent in the severe COVID-19 group. BRS was significantly lower in all patients (severe, mild, CADG), indicating significant sudden cardiac death risk.ConclusionCardiovascular autonomic neuropathy should be taken into account in COVID-19 patients’ assessment. It can be an explanation for a variety of registered manifestations, enabling a comprehensive diagnostic approach and further treatment.

Highlights

At the end of 2019, the world has faced the coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)1
Their prevalence might be attributable to metabolic abnormalities, hypoxia, and severe myocardial damage, and the administration of drugs which leads to prolongation of QTc interval
All patients were diagnosed as having COVID-19, according to WHO interim guidance (Berkwits et al, 2020; World Health Organization, 2020a), stating that “the confirmed case of COVID-19 was defined as a positive result on high throughput sequencing or real-time reverse-transcription polymerase chain reaction analysis of throat and nose swab specimens (Berkwits et al, 2020)

Summary

Introduction

At the end of 2019, the world has faced the coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The number of infected people is measured in tens of millions (Dong et al, 2020; World Health Organization, 2020b). It has initially been recognized as a serious pulmonary disease, other symptoms were soon noticed and described (Guan et al, 2020; Huang et al, 2020). Arrhythmias in COVID-19, primarily those leading to cardiac arrest, acknowledge special concern Their prevalence might be attributable to metabolic abnormalities, hypoxia, and severe myocardial damage, and the administration of drugs which leads to prolongation of QTc interval. Autonomic dysfunction (AD) has not been reported in patients with COVID-19 infection

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