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. 2023 Feb 6:14:1052369.
doi: 10.3389/fphys.2023.1052369. eCollection 2023.

Individuals with a previous symptomatic COVID-19 infection have altered heart rate and blood pressure variability during acute exercise

Jillian Chan  1 , Hailey Senior  1 , Jessica Homitz  1 , Niamh Cashin  1 , John J Guers  1
Affiliations

Individuals with a previous symptomatic COVID-19 infection have altered heart rate and blood pressure variability during acute exercise

Jillian Chan et al. Front Physiol. .

Abstract

Introduction: As the number of COVID-19 cases begin to diminish it is important to turn our attention to any long-term issues that may be associated with a prior infection. Cardiovascular defects have been noted following prior SARS-CoV-2 infections. However, less is known about how a previous infection alters the cardiovascular response to exercise. Further, differences may exist during exercise between previously SARS-CoV-2 positive individuals who had symptoms (symptomatic) relative to those who did not have symptoms (asymptomatic). We hypothesized that previously symptomatic (S) COVID-19 recoveries have an altered cardiovascular response to acute exercise relative to both control (CON; never infected), and previously COVID-19 positive asymptomatic (AS) individuals. Methods: Twenty-seven subjects (CON = 9; AS = 9; S = 9) underwent 30 min of submaximal treadmill exercise. During exercise, blood pressure was recorded on the brachial artery every 5 min and 3-lead electrocardiography was measured continuously. Indirect indicators of autonomic nervous system health: heart rate variability and blood pressure variability were measured during each session. Baseline mean arterial pressure (MAP) was taken prior to exercise in seated, standing and supine positions. Results: Blood pressure was similar (p > 0.05) amongst all three groups. There were no differences between average heart rate (HR; CON = 104 ± 4 BPM vs AS = 118 ± 6 BPM vs. S = 112 ± 3 BPM), mean arterial pressure (MAP; CON = 108 ± 4 mmHg vs. AS = 105 ± 13 mmHg vs. S = 108 ± 7 mmHg) or oxygen consumption (VO2) between groups during a bout of exercise. However, the standard deviation of the inter beat intervals of normal sinus beats, a measure of heart rate variability (HRV) (CON = 138 ± 2.8 m vs. AS = 156 ± 6 m vs. S = 77.7 ± 11 m; p < 0.05) and blood pressure variability (BPV; CON = 5.18 ± 1.1 vs. AS = 12.1 ± 0.88 mmHg vs. S = 10.2 ± 10.7 mmHg; p < 0.05) were different in our S group. Further, when HRV was assessed in the frequency domain the very low frequency was different during exercise in the S group relative to the other groups. Discussion: Collectively, these data suggest that a previous symptomatic SARS-CoV-2 infection may alter heart rate and blood pressure regulation during exercise.

Keywords: COVID-19; autonomic nervous system; blood pressure variability; cardiovascular; exercise; heart rate variability.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
There was no difference in mean arterial pressure (MAP) between groups while standing, seated, or lying. n = 9/group. Data analyzed by a Two-Way Repeated Measures ANOVA with a Bonferroni post-hoc. Data are presented as mean ± SE; MAP = mean arterial pressure. Significance was set to p < 0.05.
FIGURE 2
FIGURE 2
(A) There was no difference in average heart rate or (B) MAP before or during submaximal treadmill exercise between groups. n = 9/group; Data analyzed by a Two-Way Repeated Measures ANOVA with a Bonferroni post-hoc. Data are presented as mean ± SE; HR = heart rate; MAP = mean arterial pressure. Significance was set to p < 0.05.
FIGURE 3
FIGURE 3
Exercise significantly altered both heart rate variability (HRV) and blood pressure variability (BPV). Additionally, (A) HRV was lower during exercise in COVID-19 symptomatic individuals relative to asymptomatic and control. (B) BPV was different in the symptomatic group during exercise relative to the asymptomatic and control groups. Data analyzed by by a Two-Way Repeated Measures ANOVA with a Bonferroni post-hoc. # = symptomatic vs. control; and = symptomatic vs asymptomatic. Data are presented as mean ± SE; HRV = heart rate variability; BPV = blood pressure variability. Significance was set to p < 0.05.
FIGURE 4
FIGURE 4
Spectral analysis of HRV revealed that there was an effect of exercise in all four variables. However, there was no difference between groups for (A) total power (TP) both before and after exercise. (B) High frequency (HF) and (C) low frequency (LF) bands were not different between our groups. (D) Very low frequency (VLF) power analysis revealed that the symptomatic (S) group had lower power relative to the other groups during exercise. Data analyzed by a Two-Way Repeated Measures ANOVA with a Bonferroni post-hoc. # = symptomatic vs. control; and = symptomatic vs. asymptomatic; Data are presented as mean ± SE; HRV = heart rate variability; BPV = blood pressure variability. Significance was set to p < 0.05.
FIGURE 5
FIGURE 5
(A) There was no difference in oxygen consumption (VO2) between all three groups. (B) Respiratory exchange ratio (RER) was consistent amongst groups. Data analyzed by a Two-Way Repeated Measures ANOVA with a Bonferroni post-hoc. Data are presented as mean ± SE; VO2 = oxygen consumption; RER = respiratory exchange ratio.
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