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Published in: BMC Anesthesiology 1/2023

Open Access 01-12-2023 | Care | Research

Heart rate variability as an indicator of COVID-19 induced myocardial injury: a retrospective cohort study

Authors: Hani Taman, Nabil Mageed, Mohamed Elmorsy, Sherif Elfayoumy, Mostafa Elawady, Ahmed Farid, Mohamed Abdelmonem, Ibrahim Abdelbaser

Published in: BMC Anesthesiology | Issue 1/2023

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Abstract

Background

Heart rate variability (HRV) is a valuable indicator of autonomic nervous system integrity and can be a prognostic tool of COVID-19 induced myocardial affection. This study aimed to compare HRV indices between patients who developed myocardial injury and those without myocardial injury in COVID-19 patients who were admitted to intensive care unit (ICU).

Methods

In this retrospective study, the data from 238 COVID-19 adult patients who were admitted to ICU from April 2020 to June 2021 were collected. The patients were assigned to myocardial injury and non-myocardial injury groups. The main collected data were R-R intervals, standard deviation of NN intervals (SDANN) and the root mean square of successive differences between normal heartbeats (RMSSD) that were measured daily during the first five days of ICU admission.

Results

The R-R intervals, the SDANN and the RMSSD were significantly shorter in the myocardial injury group than the non-myocardial group at the first, t second, third, fourth and the fifth days of ICU admission. There were no significant differences between the myocardial injury and the non-myocardial injury groups with regard the number of patients who needed mechanical ventilation, ICU length of stay and the number of ICU deaths.

Conclusions

From the results of this retrospective study, we concluded that the indices of HRV were greatly affected in COVID-19 patients who developed myocardial injury.
Literature
1.
go back to reference Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33.CrossRef Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727–33.CrossRef
2.
go back to reference Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199–207.CrossRef Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199–207.CrossRef
3.
go back to reference Mageed NA. Predictive and Prognostic Value of Heart Rate Variability Analysis in Early Bedside Diagnosis and Management of COVID-19 Patients. Anaesth Surg Open Access J. 2020;1(5):1–6.CrossRef Mageed NA. Predictive and Prognostic Value of Heart Rate Variability Analysis in Early Bedside Diagnosis and Management of COVID-19 Patients. Anaesth Surg Open Access J. 2020;1(5):1–6.CrossRef
4.
go back to reference Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020;181(2):271-280.e8.CrossRef Hoffmann M, Kleine-Weber H, Schroeder S, Krüger N, Herrler T, Erichsen S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020;181(2):271-280.e8.CrossRef
5.
go back to reference Tikellis C, Thomas MC. Angiotensin-Converting Enzyme 2 (ACE2) Is a Key Modulator of the Renin Angiotensin System in Health and Disease. Int J Pept. 2012;2012:256294.CrossRef Tikellis C, Thomas MC. Angiotensin-Converting Enzyme 2 (ACE2) Is a Key Modulator of the Renin Angiotensin System in Health and Disease. Int J Pept. 2012;2012:256294.CrossRef
6.
go back to reference Saul J. Beat-To-Beat Variations of Heart Rate Reflect Modulation of Cardiac Autonomic Outflow. Physiology. 1990;5(1):32–7.CrossRef Saul J. Beat-To-Beat Variations of Heart Rate Reflect Modulation of Cardiac Autonomic Outflow. Physiology. 1990;5(1):32–7.CrossRef
7.
go back to reference Ahern DK, Gorkin L, Anderson JL, Tierney C, Hallstrom A, Ewart C, et al. Biobehavioral variables and mortality or cardiac arrest in the Cardiac Arrhythmia Pilot Study (CAPS). Am J Cardiol. 1990;66(1):59–62.CrossRef Ahern DK, Gorkin L, Anderson JL, Tierney C, Hallstrom A, Ewart C, et al. Biobehavioral variables and mortality or cardiac arrest in the Cardiac Arrhythmia Pilot Study (CAPS). Am J Cardiol. 1990;66(1):59–62.CrossRef
8.
go back to reference Casolo G, Balli E, Taddei T, Amuhasi J, Gori C. Decreased spontaneous heart rate variability in congestive heart failure. Am J Cardiol. 1989;64(18):1162–7.CrossRef Casolo G, Balli E, Taddei T, Amuhasi J, Gori C. Decreased spontaneous heart rate variability in congestive heart failure. Am J Cardiol. 1989;64(18):1162–7.CrossRef
9.
go back to reference Schmidt HB, Werdan K, Müller-Werdan U. Autonomic dysfunction in the ICU patient. Curr Opin Crit Care. 2001;7(5):314–22.CrossRef Schmidt HB, Werdan K, Müller-Werdan U. Autonomic dysfunction in the ICU patient. Curr Opin Crit Care. 2001;7(5):314–22.CrossRef
10.
go back to reference Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan. China JAMA. 2020;323(11):1061–9.CrossRef Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan. China JAMA. 2020;323(11):1061–9.CrossRef
11.
go back to reference T. K. Methodological aspects of heart rate variability analysis. In: MV K, editor. Heart Rate Variability (HRV) Signal Analysis. Boca Raton; 2013. p. 9–42. T. K. Methodological aspects of heart rate variability analysis. In: MV K, editor. Heart Rate Variability (HRV) Signal Analysis. Boca Raton; 2013. p. 9–42.
12.
go back to reference McCraty R, Shaffer F. Heart Rate Variability: New Perspectives on Physiological Mechanisms, Assessment of Self-regulatory Capacity, and Health risk. Glob Adv Heal Med. 2015;4(1):46–61.CrossRef McCraty R, Shaffer F. Heart Rate Variability: New Perspectives on Physiological Mechanisms, Assessment of Self-regulatory Capacity, and Health risk. Glob Adv Heal Med. 2015;4(1):46–61.CrossRef
13.
go back to reference Salahuddin L, Cho J, Jeong MG, Kim D. Ultra short term analysis of heart rate variability for monitoring mental stress in mobile settings. Annu Int Conf IEEE Eng Med Biol Soc IEEE Eng Med Biol Soc Annu Int Conf. 2007;2007:4656–9. Salahuddin L, Cho J, Jeong MG, Kim D. Ultra short term analysis of heart rate variability for monitoring mental stress in mobile settings. Annu Int Conf IEEE Eng Med Biol Soc IEEE Eng Med Biol Soc Annu Int Conf. 2007;2007:4656–9.
14.
go back to reference Ling N, Li C-L, Wang Z-Z, Zhang H-N, Xu H, An X-J. Heart rate variability in children with myocarditis presenting with ventricular arrhythmias. Eur Rev Med Pharmacol Sci. 2018;22(4):1102–5. Ling N, Li C-L, Wang Z-Z, Zhang H-N, Xu H, An X-J. Heart rate variability in children with myocarditis presenting with ventricular arrhythmias. Eur Rev Med Pharmacol Sci. 2018;22(4):1102–5.
15.
go back to reference Morozova MP, Lukoshkova EV, Gavrilova SA. Some aspects of heart rate variability estimation in rats. Ross Fiziol zhurnal Im IM Sechenova. 2015;101(3):291–307. Morozova MP, Lukoshkova EV, Gavrilova SA. Some aspects of heart rate variability estimation in rats. Ross Fiziol zhurnal Im IM Sechenova. 2015;101(3):291–307.
16.
go back to reference Kaliyaperumal D, Rk K, Alagesan M, Ramalingam S. Characterization of cardiac autonomic function in COVID-19 using heart rate variability: a hospital based preliminary observational study. J Basic Clin Physiol Pharmacol. 2021;32(3):247–53.CrossRef Kaliyaperumal D, Rk K, Alagesan M, Ramalingam S. Characterization of cardiac autonomic function in COVID-19 using heart rate variability: a hospital based preliminary observational study. J Basic Clin Physiol Pharmacol. 2021;32(3):247–53.CrossRef
17.
go back to reference Li-Sha G, Jing-Lin Z, Li L, Guang-Yi C, Xiao-Wei L, Yue-Chun L. Nicotine inhibits the production of proinflammatory cytokines of mice infected with coxsackievirus B3. Life Sci. 2016;148:9–16.CrossRef Li-Sha G, Jing-Lin Z, Li L, Guang-Yi C, Xiao-Wei L, Yue-Chun L. Nicotine inhibits the production of proinflammatory cytokines of mice infected with coxsackievirus B3. Life Sci. 2016;148:9–16.CrossRef
18.
go back to reference Lu S, Zhang J, Zhu Y, Zhou Y, Xiao N, Guo X, et al. A randomized clinical study on optimum proposal of integration of disease and syndrome to treat viral myocarditis. Chin J Integr Med. 2015;21(3):176–82.CrossRef Lu S, Zhang J, Zhu Y, Zhou Y, Xiao N, Guo X, et al. A randomized clinical study on optimum proposal of integration of disease and syndrome to treat viral myocarditis. Chin J Integr Med. 2015;21(3):176–82.CrossRef
19.
go back to reference Niu L, An X-J, Tian J, Wang Y. 124 cases of clinical analysis of children with viral myocarditis. Eur Rev Med Pharmacol Sci. 2015;19(15):2856–9. Niu L, An X-J, Tian J, Wang Y. 124 cases of clinical analysis of children with viral myocarditis. Eur Rev Med Pharmacol Sci. 2015;19(15):2856–9.
20.
go back to reference Cui S, Chen X-L, Jiang M-X. Study on pathological rhythm of traditional Chinese medicine about circadian distribution of premature ventricular contractions in 240 patients with viral myocarditis. Zhong Xi Yi Jie He Xue Bao. 2005;3(5):355–8.CrossRef Cui S, Chen X-L, Jiang M-X. Study on pathological rhythm of traditional Chinese medicine about circadian distribution of premature ventricular contractions in 240 patients with viral myocarditis. Zhong Xi Yi Jie He Xue Bao. 2005;3(5):355–8.CrossRef
21.
go back to reference Vijayabala J, Attapaththu M, Jayawardena P, de Silva SG, Constantine G. Sympathetic dysfunction as a cause for hypotension in dengue shock syndrome. Chin Med J (Engl). 2012;125(20):3757–8. Vijayabala J, Attapaththu M, Jayawardena P, de Silva SG, Constantine G. Sympathetic dysfunction as a cause for hypotension in dengue shock syndrome. Chin Med J (Engl). 2012;125(20):3757–8.
22.
go back to reference Griffin MP, Moorman JR. Toward the early diagnosis of neonatal sepsis and sepsis-like illness using novel heart rate analysis. Pediatrics. 2001;107(1):97–104.CrossRef Griffin MP, Moorman JR. Toward the early diagnosis of neonatal sepsis and sepsis-like illness using novel heart rate analysis. Pediatrics. 2001;107(1):97–104.CrossRef
23.
go back to reference Griffin MP, Lake DE, Moorman JR. Heart rate characteristics and laboratory tests in neonatal sepsis. Pediatrics. 2005;115(4):937–41.CrossRef Griffin MP, Lake DE, Moorman JR. Heart rate characteristics and laboratory tests in neonatal sepsis. Pediatrics. 2005;115(4):937–41.CrossRef
24.
go back to reference Carter R 3rd, Hinojosa-Laborde C, Convertino VA. Heart rate variability in patients being treated for dengue viral infection: new insights from mathematical correction of heart rate. Front Physiol. 2014;5:46.CrossRef Carter R 3rd, Hinojosa-Laborde C, Convertino VA. Heart rate variability in patients being treated for dengue viral infection: new insights from mathematical correction of heart rate. Front Physiol. 2014;5:46.CrossRef
25.
go back to reference Billman GE. The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. Front Physiol. 2013;4:26.CrossRef Billman GE. The LF/HF ratio does not accurately measure cardiac sympatho-vagal balance. Front Physiol. 2013;4:26.CrossRef
26.
go back to reference La-Orkhun V, Supachokchaiwattana P, Lertsapcharoen P, Khongphatthanayothin A. Spectrum of cardiac rhythm abnormalities and heart rate variability during the convalescent stage of dengue virus infection: a Holter study. Ann Trop Paediatr. 2011;31(2):123–8.CrossRef La-Orkhun V, Supachokchaiwattana P, Lertsapcharoen P, Khongphatthanayothin A. Spectrum of cardiac rhythm abnormalities and heart rate variability during the convalescent stage of dengue virus infection: a Holter study. Ann Trop Paediatr. 2011;31(2):123–8.CrossRef
27.
go back to reference Sharma A, Garcia GJ, Wang Y, Plummer JT, Morizono K, Arumugaswami V, et al. Human iPSC-Derived Cardiomyocytes Are Susceptible to SARS-CoV-2 Infection. Cell reports Med. 2020;1(4):100052.CrossRef Sharma A, Garcia GJ, Wang Y, Plummer JT, Morizono K, Arumugaswami V, et al. Human iPSC-Derived Cardiomyocytes Are Susceptible to SARS-CoV-2 Infection. Cell reports Med. 2020;1(4):100052.CrossRef
28.
go back to reference Chan JWM, Ng CK, Chan YH, Mok YW, Lee S, Chu Y, et al. Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS). Thorax. 2003;58:686–9. Available from: www.thoraxjnl.comCrossRef Chan JWM, Ng CK, Chan YH, Mok YW, Lee S, Chu Y, et al. Short term outcome and risk factors for adverse clinical outcomes in adults with severe acute respiratory syndrome (SARS). Thorax. 2003;58:686–9. Available from: www.​thoraxjnl.​comCrossRef
29.
go back to reference Lindner D, Fitzek A, Bräuninger H, Aleshcheva G, Edler C, Meissner K, et al. Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases. JAMA Cardiol. 2020;5(11):1281–5.CrossRef Lindner D, Fitzek A, Bräuninger H, Aleshcheva G, Edler C, Meissner K, et al. Association of Cardiac Infection With SARS-CoV-2 in Confirmed COVID-19 Autopsy Cases. JAMA Cardiol. 2020;5(11):1281–5.CrossRef
30.
go back to reference Guzik TJ, Mohiddin SA, Dimarco A, Patel V, Savvatis K, Marelli-Berg FM, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res. 2020;116(10):1666–87. Available from: https://www.arcgis.com/apps/opsdashCrossRef Guzik TJ, Mohiddin SA, Dimarco A, Patel V, Savvatis K, Marelli-Berg FM, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res. 2020;116(10):1666–87. Available from: https://​www.​arcgis.​com/​apps/​opsdashCrossRef
31.
go back to reference Chantreuil J, Favrais G, Soule N, Maakaroun-Vermesse Z, Chaillon A, Chantepie A, et al. Atrial chaotic tachycardia during a respiratory tract infection due to NL63 coronavirus. Arch Pediatr. 2013;20(3):278–81.CrossRef Chantreuil J, Favrais G, Soule N, Maakaroun-Vermesse Z, Chaillon A, Chantepie A, et al. Atrial chaotic tachycardia during a respiratory tract infection due to NL63 coronavirus. Arch Pediatr. 2013;20(3):278–81.CrossRef
32.
go back to reference Peretto G, Sala S, Rizzo S, Palmisano A, Esposito A, De Cobelli F, et al. Ventricular Arrhythmias in Myocarditis: Characterization and Relationships With Myocardial Inflammation. J Am Coll Cardiol. 2020;75(9):1046–57.CrossRef Peretto G, Sala S, Rizzo S, Palmisano A, Esposito A, De Cobelli F, et al. Ventricular Arrhythmias in Myocarditis: Characterization and Relationships With Myocardial Inflammation. J Am Coll Cardiol. 2020;75(9):1046–57.CrossRef
33.
go back to reference Zeng JH, Liu YX, Yuan J, Wang FX, Wu WB, Li JX, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection. 2020;48(5):773–7.CrossRef Zeng JH, Liu YX, Yuan J, Wang FX, Wu WB, Li JX, et al. First case of COVID-19 complicated with fulminant myocarditis: a case report and insights. Infection. 2020;48(5):773–7.CrossRef
34.
go back to reference Liu K, Fang YY, Deng Y, Liu W, Wang MF, Ma JP, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl). 2020;133(9):1025–31. Available from: www.cmj.orgCrossRef Liu K, Fang YY, Deng Y, Liu W, Wang MF, Ma JP, et al. Clinical characteristics of novel coronavirus cases in tertiary hospitals in Hubei Province. Chin Med J (Engl). 2020;133(9):1025–31. Available from: www.​cmj.​orgCrossRef
35.
go back to reference Bentzon JF, Otsuka F, Virmani R, Falk E. Mechanisms of plaque formation and rupture. Circ Res. 2014;114(12):1852–66.CrossRef Bentzon JF, Otsuka F, Virmani R, Falk E. Mechanisms of plaque formation and rupture. Circ Res. 2014;114(12):1852–66.CrossRef
36.
go back to reference Libby P, Tabas I, Fredman G, Fisher EA. Inflammation and its resolution as determinants of acute coronary syndromes. Circ Res. 2014;114(12):1867–79.CrossRef Libby P, Tabas I, Fredman G, Fisher EA. Inflammation and its resolution as determinants of acute coronary syndromes. Circ Res. 2014;114(12):1867–79.CrossRef
37.
go back to reference Mehra MR, Ruschitzka F. COVID-19 illness and heart failure: a missing link? JACC Heart Fail. 2020;8:512–4.CrossRef Mehra MR, Ruschitzka F. COVID-19 illness and heart failure: a missing link? JACC Heart Fail. 2020;8:512–4.CrossRef
38.
go back to reference Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091.CrossRef Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;368:m1091.CrossRef
39.
go back to reference Li H, Yang T-D. Vagus nerve stimulation may be used in the therapy of myocarditis. Med Hypotheses. 2009;73(5):725–7.CrossRef Li H, Yang T-D. Vagus nerve stimulation may be used in the therapy of myocarditis. Med Hypotheses. 2009;73(5):725–7.CrossRef
40.
go back to reference Nolan J, Flapan AD, Capewell S, MacDonald TM, Neilson JM, Ewing DJ. Decreased cardiac parasympathetic activity in chronic heart failure and its relation to left ventricular function. Br Heart J. 1992;67(6):482–5.CrossRef Nolan J, Flapan AD, Capewell S, MacDonald TM, Neilson JM, Ewing DJ. Decreased cardiac parasympathetic activity in chronic heart failure and its relation to left ventricular function. Br Heart J. 1992;67(6):482–5.CrossRef
Metadata
Title
Heart rate variability as an indicator of COVID-19 induced myocardial injury: a retrospective cohort study
Authors
Hani Taman
Nabil Mageed
Mohamed Elmorsy
Sherif Elfayoumy
Mostafa Elawady
Ahmed Farid
Mohamed Abdelmonem
Ibrahim Abdelbaser
Publication date
01-12-2023
Publisher
BioMed Central
Keywords
Care
COVID-19
Published in
BMC Anesthesiology / Issue 1/2023
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-023-01975-8

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