Cardiac deceleration capacity is associated with severity of inflammation in COVID-19

Abstract

Purpose: In this pilot study, we investigated the cardiac autonomic activity of coronavirus disease 2019 (COVID-19)-infected hospitalized patients. COVID-19 is characterized by cough, fever, and dyspnea, which in some severe cases can lead to hypoxia, respiratory failure, and shock. Since breathing disorders and pulmonary diseases are tightly linked to autonomic dysfunction, we analyzed the cardiac autonomic activity by measuring the deceleration capacity (DC) in COVID-19 patients.

Methods: In 14 adults (4 men and 10 women) with a median age of 63.5 years and positive for SARS-CoV-2 by polymerase chain reaction (PCR) with severe symptoms requiring hospital treatment, a high-resolution digital 30 min electrocardiogram (ECG) in Frank leads configuration was performed in a resting supine position within the first 48 h after hospital admission. DC was assessed using validated software and associated with several markers of inflammation and clinical course.

Results: The study revealed a significant association between reduced DC (≤ 2.5 ms) and older age (74 years) in COVID-19 patients, compared to those with a higher DC > 2.5 ms (56.5 years). However, the duration of hospitalization was similar for both groups. There was a nonsignificant trend towards a higher maximum viral load in patients with reduced DC. Further, patients with a DC ≤ 2.5 ms showed higher levels of inflammatory markers such as C-reactive protein (CRP) and procalcitonin (PCT), as well as leukocytosis, compared to patients with a DC > 2.5 ms. Also, the COVID-19-severity marker ferritin was significantly elevated in patients with lower DC. Other markers associated with COVID-19, such as lactate dehydrogenase (LDH) and creatine kinase (CK), exhibited comparable levels in both groups.

Conclusions: Reduced DC (≤ 2.5 ms) was significantly associated with older age, increased inflammatory markers, and elevated ferritin in patients with COVID-19. These findings suggest that DC might serve as a valuable indicator for predicting the risk of severe inflammation in COVID-19 and possibly complications associated with this disease, such as heart failure. Further studies are needed to confirm these observations and clarify the clinical significance of DC in COVID-19 and other infectious diseases.

Keywords: COVID-19; Cardiac autonomic activity; Deceleration capacity; Heart rate variability; Inflammation; SARS-CoV-2.

Fig. 1

Increased inflammatory markers and adverse baseline characteristics displayed in patients with reduced deceleration capacity (DC) of ≤ 2.5 ms compared to > 2.5 ms. A Age in years, duration of hospitalization in days, and viral load in copies/ml. B Maximum values of inflammatory markers CRP in mg/dl, PCT in ng/ml, and leukocytes in G/l. C Maximum values of COVID-19-severity markers ferritin in ng/ml, CK in U/l and LDH in U/l. Data are expressed as median. n = 6 to 8 per group. * p< 0.05, ** p < 0.01, exact p values are shown for non-significant data. CRP C-reactive protein; IL-6 interleukin 6; PCT procalcitonin; LDH lactate dehydrogenase; CK creatine kinase