■对COVID后自主神经失调的先前调查通常缺乏对照组,或仅将受影响的个体与健康志愿者进行比较。此外,目前尚无SARS-CoV-2相关性自主神经失衡患者的随访数据.
■在这项研究中,我们对患有轻度COVID-19的医护人员(HCWs)进行了全面的临床和功能随访(第1组,n=67),描绘急性后自主神经失衡的轨迹,我们之前在一项病例对照研究中发现.此外,我们评估了SARS-CoV-2感染前可进行测试的HCWs(第2组,n=29),他后来感染了SARS-CoV-2,旨在验证我们先前病例对照调查的结果。我们在健康监测访视期间通过时域和频域心率变异性分析(HRV)评估了HCW中的自主神经系统心脏调制。短期心电图(ECG)记录,在第1组的SARS-CoV-2鼻咽拭子(NPS)阴性的约6、13个月以及第6和13个月和第2组的NPS阴性的约1个月获得。使用毒品的HCWs,有合并症影响HRV,或因重症COVID-19住院的患者被排除。
■第1组在临床和功能上分为三个亚组,约6个月(A亚组,n=17),13个月(B亚组,n=37),并且在6个月和13个月时(C亚组,n=13)来自负SARS-CoV-2NPS。在A亚组中,与基线相比,6个月随访时,频域HRV参数中的频谱分量,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)(t=2.98,p=0.009)和LF/HF比率(t=3.13,p=0.006)的降低。在B亚组中,频域HRV参数中频谱分量的比较,与基线相比,在13个月的随访中,显示nHF增加(t=2.54,p=0.02);nLF降低(t=2.62,p=0.01)和LF/HF比率降低(t=4.00,p=0.0003)。在亚组C中,在6个月和13个月的随访中,在nHF中,频域HRV参数中的频谱分量高于基线(分别为t=2.64,p=0.02和(t=2.13,p=0.05);在nLF中,较低(分别为t=2.64,p=0.02和(t=2.13,p=0.05),在LF/HF中(t=1.92,p=0.08和(t=2.43,p=0.03,分别)。在6个月和13个月的随访中,有相当比例的HCWs报告了持续的COVID-19症状,似乎与心脏自主神经平衡无关.在第2组HCWs中,在1个月的随访与基线相比,频域HRV参数中的频谱分量,显示nHF减少(t=2.19,p=0.04);nLF增加(t=2.15,p=0.04)和LF/HF增加(t=3.49,p=0.002)。
■这些结果与流行病学数据一致,这些数据表明在COVID-19后的前30天内发生急性心血管并发症的风险更高。在SARS-CoV-2NPS首次阴性6个月后,轻度COVID-19恢复后,急性期SARS-CoV-2相关的自主神经失衡得以解决。然而,相当比例的医护人员报告了长期的COVID-19症状,这个点似乎与心脏自主神经平衡无关。未来的研究当然应该进一步测试自主神经失衡是否在长期COVID综合征的机制中发挥作用。
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.