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

• Published in: Frontiers in neuroscience Vol. 15; p. 640835
• Main Authors: Milovanovic, Branislav, Djajic, Vlado, Bajic, Dragana, Djokovic, Aleksandra, Krajnovic, Tatjana, Jovanovic, Sladjana, Verhaz, Antonija, Kovacevic, Pedja, Ostojic, Miodrag
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Research Foundation 21-06-2021; Frontiers Media S.A
• Subjects: Autonomic nervous system; autonomic neuropathy; Blood pressure; Cardiac arrhythmia; Cardiomyopathy; Cardiovascular diseases; cardiovascular reflex test; Coronaviruses; COVID-19; Cytokines; Diabetes mellitus; Diabetic neuropathy; Disease; Heart rate; heart rate variability; Hypotension; Hypoxia; Nervous system; Neuroscience; Parasympathetic nervous system; Pathophysiology; Patients; Pneumonia; Polymerase chain reaction; Severe acute respiratory syndrome coronavirus 2; Syncope; Bosnia-Hercegovina; COVID-19; autonomic nervous system; autonomic neuropathy; heart rate variability; cardiovascular reflex test
• ISSN: 1662-4548; 1662-453X; 1662-453X
• DOI: 10.3389/fnins.2021.640835

We 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.
Assessment of AD in the early phase of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 virus).
We 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
sex and age-matched controls.
AD (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 (
= 0.018). Orthostatic hypotension has been established in 33.0% COVID-19 patients compared to 2.6% controls (
= 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.
Cardiovascular 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.