Long term follow-up of heart rate variability in healthcare workers with mild COVID-19

Filippo Liviero, Maria Luisa Scapellato, Anna Volpin, Monica Battistella, Laura Fabris, Laura Brischigliaro, Franco Folino, Angelo Moretto, Paola Mason, Sofia Pavanello
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Abstract

Prior investigations into post-COVID dysautonomia often lacked control groups or compared affected individuals solely to healthy volunteers. In addition, no data on the follow-up of patients with SARS-CoV-2-related autonomic imbalance are available.In this study, we conducted a comprehensive clinical and functional follow-up on healthcare workers (HCWs) with former mild COVID-19 (group 1, n = 67), to delineate the trajectory of post-acute autonomic imbalance, we previously detected in a case–control study. Additionally, we assessed HCWs for which a test before SARS-CoV-2 infection was available (group 2, n = 29), who later contracted SARS-CoV-2, aiming to validate findings from our prior case–control investigation. We evaluated autonomic nervous system heart modulation by means of time and frequency domain heart rate variability analysis (HRV) in HCWs during health surveillance visits. Short-term electrocardiogram (ECG) recordings, were obtained at about 6, 13 months and both at 6 and 13 months from the negative SARS-CoV-2 naso-pharyngeal swab (NPS) for group 1 and at about 1-month from the negative NPS for group 2. HCWs who used drugs, had comorbidities that affected HRV, or were hospitalized with severe COVID-19 were excluded.Group 1 was split into three subgroups clinically and functionally followed at, about 6 months (subgroup-A, n = 17), 13 months (subgroup-B, n = 37) and both at 6 and 13 months (subgroup-C, n = 13) from the negative SARS-CoV-2 NPS. In subgroup-A, at 6-month follow-up compared with baseline, the spectral components in the frequency domain HRV parameters, showed an increase in normalized high frequency power (nHF) (t = 2.99, p = 0.009), a decrease in the normalized low frequency power (nLF) (t = 2.98, p = 0.009) and in the LF/HF ratio (t = 3.13, p = 0.006). In subgroup B, the comparison of the spectral components in the frequency domain HRV parameters, at 13-month follow-up compared with baseline, showed an increase in nHF (t = 2.54, p = 0.02); a decrease in nLF (t = 2.62, p = 0.01) and in the LF/HF ratio (t = 4.00, p = 0.0003). In subgroup-C, at both 6 and 13-month follow-ups, the spectral components in the frequency domain HRV parameters were higher than baseline in nHF (t = 2.64, p = 0.02 and (t = 2.13, p = 0.05, respectively); lower in nLF (t = 2.64, p = 0.02 and (t = 2.13, p = 0.05, respectively), and in LF/HF (t = 1.92, p = 0.08 and (t = 2.43, p = 0.03, respectively). A significant proportion of HCWs reported persistent COVID-19 symptoms at both the 6 and 13-month follow-ups, seemingly unrelated to cardiac autonomic balance. In group 2 HCWs, at 1-month follow-up compared with baseline, the spectral components in the frequency domain HRV parameters, showed a decrease in nHF (t = 2.19, p = 0.04); an increase in nLF (t = 2.15, p = 0.04) and in LF/HF (t = 3.49, p = 0.002).These results are consistent with epidemiological data suggesting a higher risk of acute cardiovascular complications during the first 30 days after COVID-19. The SARS-CoV-2 associated autonomic imbalance in the post-acute phase after recovery of mild COVID-19 resolved 6 months after the first negative SARS-CoV-2 NPS. However, a significant proportion of HCWs reported long-term COVID-19 symptoms, which dot not seems to be related to cardiac autonomic balance. Future research should certainly further test whether autonomic imbalance has a role in the mechanisms of long-COVID syndrome.
对患有轻度 COVID-19 的医护人员的心率变异性进行长期随访
之前对感染 COVID 后自主神经失调症的研究往往缺乏对照组,或仅将患者与健康志愿者进行比较。在本研究中,我们对曾患有轻度 COVID-19 (第 1 组,n = 67)的医护人员(HCWs)进行了全面的临床和功能随访,以勾勒出我们之前在病例对照研究中发现的急性自主神经失衡后的轨迹。此外,我们还评估了在感染 SARS-CoV-2 之前接受过检测的高危人群(第 2 组,n = 29),他们后来感染了 SARS-CoV-2,目的是验证我们之前的病例对照调查的结果。我们通过时域和频域心率变异性分析(HRV)评估了健康监测访问中高危人群的自律神经系统心脏调节情况。我们分别在第 1 组 SARS-CoV-2 鼻咽拭子(NPS)阴性后约 6 个月、13 个月以及第 2 组 SARS-CoV-2 鼻咽拭子阴性后约 1 个月采集了短期心电图(ECG)记录。第一组被分为三个亚组,分别在 SARS-CoV-2 NPS 阴性后约 6 个月(A 亚组,n = 17)、13 个月(B 亚组,n = 37)以及 6 个月和 13 个月(C 亚组,n = 13)进行临床和功能随访。在亚组 A 中,与基线相比,随访 6 个月时,频域心率变异参数中的频谱成分显示归一化高频功率(nHF)增加(t = 2.99,p = 0.009),归一化低频功率(nLF)减少(t = 2.98,p = 0.009),低频/高频比值减少(t = 3.13,p = 0.006)。在 B 亚组中,13 个月随访时与基线相比,频域心率变异参数的频谱成分比较显示 nHF 增加(t = 2.54,p = 0.02);nLF 减少(t = 2.62,p = 0.01),LF/HF 比值减少(t = 4.00,p = 0.0003)。在 C 亚组中,在 6 个月和 13 个月的随访中,nHF 的频域心率变异参数的频谱成分均高于基线(t = 2.64,p = 0.02 和(t = 2.13, p = 0.05, respectively);nLF(t = 2.64, p = 0.02 and (t = 2.13, p = 0.05, respectively)和 LF/HF(t = 1.92, p = 0.08 and (t = 2.43, p = 0.03, respectively)分别低于基线。相当一部分高危产妇在 6 个月和 13 个月的随访中都报告了持续的 COVID-19 症状,这似乎与心脏自主神经平衡无关。在第 2 组高危人群中,与基线相比,随访 1 个月时,频域心率变异参数的频谱成分显示 nHF 下降(t = 2.19,p = 0.04);nLF 上升(t = 2.15,p = 0.04),LF/HF 上升(t = 3.49,p = 0.002)。在轻度 COVID-19 恢复后的急性期,与 SARS-CoV-2 相关的自律神经失衡在首次 SARS-CoV-2 NPS 阴性后 6 个月得到缓解。然而,相当一部分高危工人报告了长期的 COVID-19 症状,而这些症状点似乎与心脏自律神经平衡无关。未来的研究肯定要进一步检验自律神经失衡是否在长期 COVID 综合征的发病机制中发挥作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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