Decreased Heart Rate Variability in COVID-19
Abstract Purpose Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which primarily infects the lower airways and binds to angiotensin-converting enzyme 2 (ACE2) on alveolar epithelial cells. ACE2 is widely expressed not only in the lungs b...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Springer
2022-12-01
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| Series: | Intensive Care Research |
| Subjects: | |
| Online Access: | https://doi.org/10.1007/s44231-022-00024-1 |
| _version_ | 1797636930205122560 |
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| author | Chengfen Yin Jianguo Li Zhiyong Wang Yongle Zhi Lei Xu |
| author_facet | Chengfen Yin Jianguo Li Zhiyong Wang Yongle Zhi Lei Xu |
| author_sort | Chengfen Yin |
| collection | DOAJ |
| description | Abstract Purpose Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which primarily infects the lower airways and binds to angiotensin-converting enzyme 2 (ACE2) on alveolar epithelial cells. ACE2 is widely expressed not only in the lungs but also in the cardiovascular system. Therefore, SARS-CoV-2 can also damage the myocardium. This report aimed to highlight decreased heart rate variability (HRV) and cardiac injury caused by SARS-CoV-2. Materials and Methods We evaluated three COVID-19 patients who died. Patients’ data were collected from electronic medical records. We collected patient’s information, including baseline information, lab results, body temperature, heart rate (HR), clinical outcome and other related data. We calculated the HRV and the difference between the expected and actual heart rate changes as the body temperature increased. Results As of March 14, 2020, 3 (2.2%) of 136 patients with COVID-19 in Tianjin died in the early stage of the COVID-19 epidemic. The immediate cause of death for Case 1, Case 2, and Case 3 was cardiogenic shock, cardiac arrest and cardiac arrest, respectively. The HRV were substantially decreased in the whole course of all three cases. The actual increases in heart rate were 5 beats/min, 13 beats/min, and 4 beats/min, respectively, less than expected as their temperature increased. Troponin I and Creatine Kinase MB isoenzyme (CK-MB) were substantially increased only in Case 3, for whom the diagnosis of virus-related cardiac injury could not be made until day 7. In all three cases, decreased in HRV and HR changes occurred earlier than increases in cardiac biomarkers (e.g., troponin I and CK-MB). Conclusions In conclusion, COVID-19 could affect HRV and counteract tachycardia in response to increases in body temperature. The decreases of HRV and HR changes happened earlier than the increases of myocardial markers (troponin I and CK-MB). It suggested the decreases of HRV and HR changes might help predict cardiac injury earlier than myocardial markers in COVID-19, thus its early identification might help improve patient prognosis. |
| first_indexed | 2024-03-11T12:41:09Z |
| format | Article |
| id | doaj.art-dc8ead1c0edd4761b37d14f3981908c6 |
| institution | Directory Open Access Journal |
| issn | 2666-9862 |
| language | English |
| last_indexed | 2024-03-11T12:41:09Z |
| publishDate | 2022-12-01 |
| publisher | Springer |
| record_format | Article |
| series | Intensive Care Research |
| spelling | doaj.art-dc8ead1c0edd4761b37d14f3981908c62023-11-05T12:19:00ZengSpringerIntensive Care Research2666-98622022-12-0131879110.1007/s44231-022-00024-1Decreased Heart Rate Variability in COVID-19Chengfen Yin0Jianguo Li1Zhiyong Wang2Yongle Zhi3Lei Xu4Department of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary DiseaseDepartment of Respiratory and Critical Medicine, Tianjin Haihe HospitalDepartment of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary DiseaseDepartment of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary DiseaseDepartment of Critical Care Medicine, Tianjin Third Central Hospital, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary DiseaseAbstract Purpose Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which primarily infects the lower airways and binds to angiotensin-converting enzyme 2 (ACE2) on alveolar epithelial cells. ACE2 is widely expressed not only in the lungs but also in the cardiovascular system. Therefore, SARS-CoV-2 can also damage the myocardium. This report aimed to highlight decreased heart rate variability (HRV) and cardiac injury caused by SARS-CoV-2. Materials and Methods We evaluated three COVID-19 patients who died. Patients’ data were collected from electronic medical records. We collected patient’s information, including baseline information, lab results, body temperature, heart rate (HR), clinical outcome and other related data. We calculated the HRV and the difference between the expected and actual heart rate changes as the body temperature increased. Results As of March 14, 2020, 3 (2.2%) of 136 patients with COVID-19 in Tianjin died in the early stage of the COVID-19 epidemic. The immediate cause of death for Case 1, Case 2, and Case 3 was cardiogenic shock, cardiac arrest and cardiac arrest, respectively. The HRV were substantially decreased in the whole course of all three cases. The actual increases in heart rate were 5 beats/min, 13 beats/min, and 4 beats/min, respectively, less than expected as their temperature increased. Troponin I and Creatine Kinase MB isoenzyme (CK-MB) were substantially increased only in Case 3, for whom the diagnosis of virus-related cardiac injury could not be made until day 7. In all three cases, decreased in HRV and HR changes occurred earlier than increases in cardiac biomarkers (e.g., troponin I and CK-MB). Conclusions In conclusion, COVID-19 could affect HRV and counteract tachycardia in response to increases in body temperature. The decreases of HRV and HR changes happened earlier than the increases of myocardial markers (troponin I and CK-MB). It suggested the decreases of HRV and HR changes might help predict cardiac injury earlier than myocardial markers in COVID-19, thus its early identification might help improve patient prognosis.https://doi.org/10.1007/s44231-022-00024-1Angiotensin converting enzyme 2Coronavirus disease 2019PrognosisTachycardiaTemperatureMyocardium |
| spellingShingle | Chengfen Yin Jianguo Li Zhiyong Wang Yongle Zhi Lei Xu Decreased Heart Rate Variability in COVID-19 Intensive Care Research Angiotensin converting enzyme 2 Coronavirus disease 2019 Prognosis Tachycardia Temperature Myocardium |
| title | Decreased Heart Rate Variability in COVID-19 |
| title_full | Decreased Heart Rate Variability in COVID-19 |
| title_fullStr | Decreased Heart Rate Variability in COVID-19 |
| title_full_unstemmed | Decreased Heart Rate Variability in COVID-19 |
| title_short | Decreased Heart Rate Variability in COVID-19 |
| title_sort | decreased heart rate variability in covid 19 |
| topic | Angiotensin converting enzyme 2 Coronavirus disease 2019 Prognosis Tachycardia Temperature Myocardium |
| url | https://doi.org/10.1007/s44231-022-00024-1 |
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