Exercise Intolerance and Excessive Chronotropic Response Due to Possible Autonomic Dysfunction Post COVID-19 Infection  

作　　者：Stefanos Archontakis Dimitrios Venetsanos Nikias Milaras Eirini Beneki Panagiotis Dourvas Epameinondas Triantafyllou Konstantinos Sideris Konstantina Aggeli Petros Arsenos Athanasios Kordalis Konstantinos Gatzoulis Skevos Sideris Stefanos Archontakis;Dimitrios Venetsanos;Nikias Milaras;Eirini Beneki;Panagiotis Dourvas;Epameinondas Triantafyllou;Konstantinos Sideris;Konstantina Aggeli;Petros Arsenos;Athanasios Kordalis;Konstantinos Gatzoulis;Skevos Sideris(Department of Cardiology, Hippokration General Hospital, Athens, Greece;First Cardiology Division, Hippokration General Hospital, Medical School, University of Athens, Athens, Greece)

机构地区：[1]Department of Cardiology, Hippokration General Hospital, Athens, Greece [2]First Cardiology Division, Hippokration General Hospital, Medical School, University of Athens, Athens, Greece

出　　处：《International Journal of Clinical Medicine》2023年第12期540-551,共12页临床医学国际期刊(英文)

摘　　要：Introduction and Objectives: In patients with Post-Acute Sequelae of Coronavirus 2 infection (PASC), a post infectious autonomic dysfunction may be one of the underlying mechanisms. Patients often present with exercise intolerance and exaggerated heart rate response to exercise. We report a single centre experience of patients with PACS and suspected autonomic dysfunction. Methods: Forty-two patients evaluated in the Outpatient Cardiology Department with suspected PASC were included in the study. Patients complained of compromised exercise performance persisting >3 months after recovery from COVID-19 infection, compared to the pre-COVID-19 period. The patients were evaluated with 12-lead electrocardiogram, echocardiography, 24-hour ECG ambulatory monitoring and either exercise stress test or a 6-minute walk test. Results: All 42 patients demonstrated an exaggerated chronotropic response, defined as the inappropriate increase in heart rate before the 6th minute of exercise >100% of the age-predicted maximal heart rate value with reproduction of clinical symptoms. In addition, 24-hour ambulatory electrocardiography revealed an increased mean heart rate of 92 beats/minute and decreased mean standard deviation of sequential 5-minute N-N interval (SDNN) of 74.4 ms. Pharmaceutical treatment with b-blockers, ivabradine or both was administrated in 29 (69%) resulting in symptomatic improvement in 82.8% of those under treatment. However, residual symptoms persisted in 69% of patients after 3 months. Conclusions: In patients with “Post-acute COVID-19” syndrome, we found an excessive chronotropic response to exercise suggesting autonomic dysfunction as the underlying mechanism of symptoms. Treatment with beta blockers or ivabradine resulted in clinical improvement but a substantial proportion of patients remained symptomatic.Introduction and Objectives: In patients with Post-Acute Sequelae of Coronavirus 2 infection (PASC), a post infectious autonomic dysfunction may be one of the underlying mechanisms. Patients often present with exercise intolerance and exaggerated heart rate response to exercise. We report a single centre experience of patients with PACS and suspected autonomic dysfunction. Methods: Forty-two patients evaluated in the Outpatient Cardiology Department with suspected PASC were included in the study. Patients complained of compromised exercise performance persisting >3 months after recovery from COVID-19 infection, compared to the pre-COVID-19 period. The patients were evaluated with 12-lead electrocardiogram, echocardiography, 24-hour ECG ambulatory monitoring and either exercise stress test or a 6-minute walk test. Results: All 42 patients demonstrated an exaggerated chronotropic response, defined as the inappropriate increase in heart rate before the 6th minute of exercise >100% of the age-predicted maximal heart rate value with reproduction of clinical symptoms. In addition, 24-hour ambulatory electrocardiography revealed an increased mean heart rate of 92 beats/minute and decreased mean standard deviation of sequential 5-minute N-N interval (SDNN) of 74.4 ms. Pharmaceutical treatment with b-blockers, ivabradine or both was administrated in 29 (69%) resulting in symptomatic improvement in 82.8% of those under treatment. However, residual symptoms persisted in 69% of patients after 3 months. Conclusions: In patients with “Post-acute COVID-19” syndrome, we found an excessive chronotropic response to exercise suggesting autonomic dysfunction as the underlying mechanism of symptoms. Treatment with beta blockers or ivabradine resulted in clinical improvement but a substantial proportion of patients remained symptomatic.

关 键 词：COVID-19 Autonomic Neuropathy Exertional Intolerance Exaggerated Chronotropic Response POTS DYSAUTONOMIA 

分 类 号：R73[医药卫生—肿瘤]