Autonomic cardiac function in children and adolescents with long COVID: a case-controlled study, 2024, Delogu et al

Autonomic cardiac function in children and adolescents with long COVID: a case-controlled study

A B Delogu, C Aliberti, L Birritella, G De Rosa, C De Rose, R Morello, N Cambise, A G Marino, A Belmusto, L Tinti, A Di Renzo, G A Lanza, D Buonsenso

Published: 6 March 2024

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Abstract
Although the mechanisms underlying the pathophysiology of long COVID condition are still debated, there is growing evidence that autonomic dysfunction may play a role in the long-term complications or persisting symptoms observed in a significant proportion of patients after SARS-CoV-2 infection. However, studies focused on autonomic dysfunction have primarily been conducted in adults, while autonomic function has not yet been investigated in pediatric subjects. In this study, for the first time, we assessed whether pediatric patients with long COVID present abnormalities in autonomic cardiac function.

Fifty-six long COVID pediatric patients (mean age 10.3 ± 3.8 y) and 27 age-, sex-, and body surface area-matched healthy controls (mean age 10.4 ± 4.5y) underwent a standard 12-lead electrocardiography (ECG) and 24-h ECG Holter monitoring. Autonomic cardiac function was assessed by time-domain and frequency-domain heart rate variability parameters. A comprehensive echocardiographic study was also obtained by two-dimensional echocardiography and tissue Doppler imaging.

Data analysis showed that pediatric patients with long COVID had significant changes in HRV variables compared to healthy controls: significantly lower r-MSSD (root mean square of successive RR interval differences, 47.4 ± 16.9 versus 60.4 ± 29.1, p = 0.02), significant higher values VLF (very low frequency, 2077.8 ± 1023.3 versus 494.3 ± 1015.5 ms, p = 0.000), LF (low frequency, 1340.3 ± 635.6 versus 354.6 ± 816.8 ms, p = 0.000), and HF (high frequency, 895.7 ± 575.8 versus 278.9 ± 616.7 ms, p = 0.000). No significant differences were observed between the two groups both in systolic and diastolic parameters by echocardiography.

Conclusion: These findings suggest that pediatric patients with long COVID have an imbalance of cardiac autonomic function toward a relative predominance of parasympathetic tone, as already reported in adult patients with long COVID. Further studies are needed to clarify the clinical significance of this autonomic dysfunction and demonstrate its role as a pathophysiological mechanism of long COVID, paving the way for effective therapeutic and preventive strategies.

Link | PDF (European Journal of Pediatrics) [Open Access]

 

If the parasympathetic is the more restful one (“rest-and-digest”) and it’s already overstimulated, why is everyone going on about boosting it and “calming the nervous system” as if it will magically cure ME/LC.

 

Mostly because the part that is assumed to be overactive is the sympathetic one and facts are irrelevant here. Everything has been made to be about reducing stress and this being all about too much stress, or whatever, so it must be the stress response and that's assumed to be all about the sympathetic system, even though they work in a state of dynamic equilibrium without a clear demarcation.

Same thing with cortisol, or this being depression, or deconditioning. Doesn't even matter that it's been debunked, it's still claimed because everything biopsychosocial is about narratives and cherry-picking. It's a complete fact-free zone.