{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:50:25Z","timestamp":1788537025210,"version":"build-2803163510"},"reference-count":106,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T00:00:00Z","timestamp":1693526400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Long COVID is characterized by persistent signs and symptoms that continue or develop for more than 4 weeks after acute COVID-19 infection. Patients with Long COVID experience a cardiovascular autonomic imbalance known as dysautonomia. However, the underlying autonomic pathophysiological mechanisms behind this remain unclear. Current hypotheses include neurotropism, cytokine storms, and inflammatory persistence. Certain immunological factors indicate autoimmune dysfunction, which can be used to identify patients at a higher risk of Long COVID. Heart rate variability can indicate autonomic imbalances in individuals suffering from Long COVID, and measurement is a non-invasive and low-cost method for assessing cardiovascular autonomic modulation. Additionally, biochemical inflammatory markers are used for diagnosing and monitoring Long COVID. These inflammatory markers can be used to improve the understanding of the mechanisms driving the inflammatory response and its effects on the sympathetic and parasympathetic pathways of the autonomic nervous system. Autonomic imbalances in patients with Long COVID may result in lower heart rate variability, impaired vagal activity, and substantial sympathovagal imbalance. New research on this subject must be encouraged to enhance the understanding of the long-term risks that cardiovascular autonomic imbalances can cause in individuals with Long COVID.<\/jats:p>","DOI":"10.3389\/fcvm.2023.1256512","type":"journal-article","created":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T07:13:19Z","timestamp":1693552399000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":64,"title":["Cardiovascular autonomic dysfunction in \u201cLong COVID\u201d: pathophysiology, heart rate variability, and inflammatory markers"],"prefix":"10.3389","volume":"10","author":[{"given":"Karina Carvalho","family":"Marques","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juarez Ant\u00f4nio Sim\u00f5es","family":"Quaresma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz F\u00e1bio Magno","family":"Falc\u00e3o","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,9,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1007\/s10787-023-01194-0","article-title":"What is really \u2018long COVID'?","volume":"31","author":"Szabo","year":"2023","journal-title":"Inflammopharmacology"},{"key":"B2","doi-asserted-by":"publisher","first-page":"4350","DOI":"10.3390\/ijerph18084350","article-title":"Long COVID-19: proposed primary care clinical guidelines for diagnosis and disease management","volume":"18","author":"Sis\u00f3-Almirall","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B3","doi-asserted-by":"publisher","first-page":"103071","DOI":"10.1016\/j.autrev.2022.103071","article-title":"The autonomic aspects of the post-COVID19 syndrome","volume":"21","author":"Dotan","year":"2022","journal-title":"Autoimmun Rev"},{"key":"B4","doi-asserted-by":"publisher","first-page":"14042","DOI":"10.1038\/s41598-021-93546-5","article-title":"Clinical characterization of dysautonomia in long COVID-19 patients","volume":"11","author":"Barizien","year":"2021","journal-title":"Sci Rep"},{"key":"B5","doi-asserted-by":"publisher","first-page":"297","DOI":"10.3390\/jcdd10070297","article-title":"Assessment and therapeutic modulation of heart rate variability: potential implications in patients with COVID-19","volume":"10","author":"Schnekenberg","year":"2023","journal-title":"J Cardiovasc Dev Dis"},{"key":"B6","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1016\/B978-0-444-53491-0.00031-6","article-title":"Heart rate variability","volume":"117","author":"Cygankiewicz","year":"2013","journal-title":"Handb Clin Neurol"},{"key":"B7","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1111\/j.1542-474x.1996.tb00275.x","article-title":"Heart rate variability","volume":"1","author":"Malik","year":"1996","journal-title":"Ann Noninvasive Electrocardiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1055445","DOI":"10.3389\/fnins.2023.105544","article-title":"The connection between heart rate variability (HRV), neurological health, and cognition: a literature review","volume":"17","author":"Arakaki","year":"2023","journal-title":"Front Neurosci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"156","DOI":"10.3390\/jcdd8110156","article-title":"Post-acute sequelae of COVID-19 and cardiovascular autonomic dysfunction: what do we know?","volume":"8","author":"Bisaccia","year":"2021","journal-title":"J Cardiovasc Dev Dis"},{"key":"B10","doi-asserted-by":"publisher","first-page":"869","DOI":"10.1016\/j.dsx.2021.04.007","article-title":"Long COVID: an overview","volume":"15","author":"Raveendran","year":"2021","journal-title":"Diabetes Metab Syndr"},{"key":"B11","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1186\/s12879-022-07181-0","article-title":"Severe post-COVID-19 dysautonomia: a case report","volume":"22","author":"Bosco","year":"2022","journal-title":"BMC Infect Dis"},{"key":"B12","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1038\/s41569-021-00665-7","article-title":"Current and novel biomarkers of thrombotic risk in COVID-19: a consensus statement from the international COVID-19 thrombosis biomarkers colloquium","volume":"19","author":"Gorog","year":"2022","journal-title":"Nat Rev Cardiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1373","DOI":"10.3390\/diagnostics12061373","article-title":"Inflammatory and cardiac biomarkers in relation with post-acute COVID-19 and mortality: what we know after successive pandemic waves","volume":"12","author":"Lionte","year":"2022","journal-title":"Diagnostics"},{"key":"B14","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1007\/s00246-022-03020-w","article-title":"Long-term cardiovascular outcomes of multisystem inflammatory syndrome in children associated with COVID-19 using an institution based algorithm","volume":"44","author":"Chakraborty","year":"2023","journal-title":"Pediatr Cardiol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"6396","DOI":"10.26355\/eurrev_202209_29667","article-title":"Long-term predictive value of cardiac biomarkers in patients with COVID-19 infection","volume":"26","author":"Sabanoglu","year":"2022","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.1002\/iid3.471","article-title":"Cardiac biomarkers, cardiac injury, and comorbidities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis","volume":"9","author":"Zhu","year":"2021","journal-title":"Immun Inflamm Dis"},{"key":"B17","doi-asserted-by":"publisher","first-page":"385","DOI":"10.1007\/s10286-021-00803-8","article-title":"Autonomic dysfunction following COVID-19 infection: an early experience","volume":"31","author":"Shouman","year":"2021","journal-title":"Clin Auton Res"},{"key":"B18","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1007\/s00415-021-10655-x","article-title":"Long COVID: cognitive complaints (brain fog) and dysfunction of the cingulate cortex","volume":"269","author":"Hugon","year":"2022","journal-title":"J Neurol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"104707","DOI":"10.1016\/j.jbc.2023.104707","article-title":"SARS-CoV-2 spike ectodomain targets \u03b17 nicotinic acetylcholine receptors","volume":"299","author":"O'Brien","year":"2023","journal-title":"J Biol Chem"},{"key":"B20","doi-asserted-by":"publisher","first-page":"1594","DOI":"10.1016\/j.immuni.2021.06.002","article-title":"Deep spatial profiling of human COVID-19 brains reveals neuroinflammation with distinct microanatomical microglia-T-cell interactions","volume":"54","author":"Schwabenland","year":"2021","journal-title":"Immunity"},{"key":"B21","doi-asserted-by":"publisher","first-page":"102608","DOI":"10.1016\/j.conb.2022.102608","article-title":"Neuroinflammation and COVID-19","volume":"76","author":"Vanderheiden","year":"2022","journal-title":"Curr Opin Neurobiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"20406223221076890","DOI":"10.1177\/20406223221076890","article-title":"Neurological manifestations of long-COVID syndrome: a narrative review","volume":"13","author":"Stefanou","year":"2022","journal-title":"Ther Adv Chronic Dis"},{"key":"B23","doi-asserted-by":"publisher","first-page":"689","DOI":"10.1021\/acschemneuro.2c00610","article-title":"SARS-CoV-2 spike protein downregulates cell surface \u03b17nAChR through a helical motif in the spike neck","volume":"14","author":"Tillman","year":"2023","journal-title":"ACS Chem Neurosci"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1850","DOI":"10.1007\/s12035-021-02696-0","article-title":"Could SARS-CoV-2 spike protein be responsible for long-COVID syndrome?","volume":"59","author":"Theoharides","year":"2022","journal-title":"Mol Neurobiol"},{"key":"B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.cytogfr.2021.02.002","article-title":"SARS-CoV-2 mediated neuroinflammation and the impact of COVID-19 in neurological disorders","volume":"58","author":"Amruta","year":"2021","journal-title":"Cytokine Growth Factor Rev"},{"key":"B26","doi-asserted-by":"publisher","first-page":"992384","DOI":"10.3389\/fimmu.2022.992384","article-title":"Pathophysiological mechanisms of thrombosis in acute and long COVID-19","volume":"13","author":"Jing","year":"2022","journal-title":"Front Immunol"},{"key":"B27","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1177\/10815589231158041","article-title":"The role of immune activation and antigen persistence in acute and long COVID","volume":"71","author":"Opsteen","year":"2023","journal-title":"J Investig Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"848886","DOI":"10.3389\/fimmu.2022.848886","article-title":"Persistent overactive cytotoxic immune response in a spanish cohort of individuals with long-COVID: identification of diagnostic biomarkers","volume":"13","author":"Gal\u00e1n","year":"2022","journal-title":"Front Immunol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1038\/s41590-021-01113-x","article-title":"Immunological dysfunction persists for 8 months following initial mild-to-moderate SARS-CoV-2 infection","volume":"23","author":"Phetsouphanh","year":"2022","journal-title":"Nat Immunol"},{"key":"B30","doi-asserted-by":"publisher","first-page":"2155","DOI":"10.1093\/infdis\/jiac017","article-title":"Persistent autoimmune activation and proinflammatory state in post-coronavirus disease 2019 syndrome","volume":"225","author":"Acosta-Ampudia","year":"2022","journal-title":"J Infect Dis"},{"key":"B31","doi-asserted-by":"publisher","first-page":"6076","DOI":"10.1007\/s12035-022-02947-8","article-title":"A functional interaction between Y674-R685 region of the SARS-CoV-2 spike protein and the human \u03b17 nicotinic receptor","volume":"59","author":"Chrestia","year":"2022","journal-title":"Mol Neurobiol"},{"key":"B32","doi-asserted-by":"publisher","first-page":"10.1111\/cen3.12703","DOI":"10.1111\/cen3.12703","article-title":"Inflammatory reflex disruption in COVID-19","volume":"29","author":"Hajiasgharzadeh","year":"2022","journal-title":"Clin Exp Neuroimmunol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"103230","DOI":"10.1016\/j.autrev.2022.103230","article-title":"Autoimmune autonomic nervous system imbalance and conditions: chronic fatigue syndrome, fibromyalgia, silicone breast implants, COVID and post-COVID syndrome, sick building syndrome, post-orthostatic tachycardia syndrome, autoimmune diseases and autoimmune\/inflammatory syndrome induced by adjuvants","volume":"22","author":"Malkova","year":"2023","journal-title":"Autoimmun Rev"},{"key":"B34","doi-asserted-by":"publisher","first-page":"112009","DOI":"10.1016\/j.fct.2021.112009","article-title":"Nicotinic cholinergic system and COVID-19: in silico identification of interactions between \u03b17 nicotinic acetylcholine receptor and the cryptic epitopes of SARS-Co-V and SARS-CoV-2 spike glycoproteins","volume":"149","author":"Lagoumintzis","year":"2021","journal-title":"Food Chem Toxicol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"112184","DOI":"10.1016\/j.fct.2021.112184","article-title":"Is SARS-CoV-2 spike glycoprotein impairing macrophage function via \u03b17-nicotinic acetylcholine receptors?","volume":"152","author":"Tanmay","year":"2021","journal-title":"Food Chem Toxicol"},{"key":"B36","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/j.bbi.2019.03.009","article-title":"Heart rate variability and inflammation: a meta-analysis of human studies","volume":"80","author":"Williams","year":"2019","journal-title":"Brain Behav Immun"},{"key":"B37","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.autneu.2014.01.004","article-title":"Sympathetic nervous system and inflammation: a conceptual view","volume":"182","author":"J\u00e4nig","year":"2014","journal-title":"Auton Neurosci"},{"key":"B38","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1146\/annurev-immunol-042617-053158","article-title":"Molecular and functional neuroscience in immunity","volume":"36","author":"Pavlov","year":"2018","journal-title":"Annu Rev Immunol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"497","DOI":"10.3390\/vaccines9050497","article-title":"Post-COVID syndrome: an insight on its pathogenesis","volume":"9","author":"Maltezou","year":"2021","journal-title":"Vaccines"},{"key":"B40","doi-asserted-by":"publisher","first-page":"e63","DOI":"10.7861\/clinmed.2020-0896","article-title":"Autonomic dysfunction in \u201clong COVID\u201d: rationale, physiology and management strategies","volume":"21","author":"Dani","year":"2021","journal-title":"Clin Med"},{"key":"B41","doi-asserted-by":"publisher","first-page":"4768","DOI":"10.7150\/ijbs.75056","article-title":"Long COVID and its management","volume":"18","author":"Koc","year":"2022","journal-title":"Int J Biol Sci"},{"key":"B42","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1136\/jim-2021-002051","article-title":"Long COVID following mild SARS-CoV-2 infection: characteristic T cell alterations and response to antihistamines","volume":"70","author":"Glynne","year":"2022","journal-title":"J Investig Med"},{"key":"B43","doi-asserted-by":"publisher","first-page":"11","DOI":"10.36290\/vnl.2022.100","article-title":"Inflammatory markers in clinical practice","volume":"68","author":"Sotak","year":"2022","journal-title":"Vnitr Lek"},{"key":"B44","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1080\/07853890.2016.1226512","article-title":"Heart rate, heart rate variability and inflammatory biomarkers among young and healthy adults","volume":"49","author":"Aeschbacher","year":"2017","journal-title":"Ann Med"},{"key":"B45","doi-asserted-by":"publisher","first-page":"1557","DOI":"10.3390\/life12101557","article-title":"C-Reactive protein as a potential peripheral biomarker for high-lethality suicide attempts","volume":"12","author":"Aguglia","year":"2022","journal-title":"Life"},{"key":"B46","doi-asserted-by":"publisher","first-page":"1040024","DOI":"10.3389\/fimmu.2022.1040024","article-title":"C-Reactive protein (CRP): a poor prognostic biomarker in COVID-19","volume":"13","author":"Bouayed","year":"2022","journal-title":"Front Immunol"},{"key":"B47","doi-asserted-by":"publisher","first-page":"714426","DOI":"10.3389\/fmed.2021.714426","article-title":"Serum metabolic profile in patients with long-COVID (PASC) syndrome: clinical implications","volume":"8","author":"Pasini","year":"2021","journal-title":"Front Med"},{"key":"B48","doi-asserted-by":"publisher","first-page":"930445","DOI":"10.3389\/fimmu.2022.930445","article-title":"Heart rate as a non-invasive biomarker of inflammation: implications for digital health","volume":"13","author":"Frasch","year":"2022","journal-title":"Front Immunol"},{"key":"B49","doi-asserted-by":"publisher","first-page":"100273","DOI":"10.1016\/j.bbih.2021.100273","article-title":"Heart rate variability and circulating inflammatory markers in midlife","volume":"15","author":"Alen N","year":"2021","journal-title":"Brain Behav Immun Health"},{"key":"B50","doi-asserted-by":"publisher","first-page":"1305","DOI":"10.1016\/j.psyneuen.2008.08.007","article-title":"The relationship between heart rate variability and inflammatory markers in cardiovascular diseases","volume":"33","author":"Haensel","year":"2008","journal-title":"Psychoneuroendocrinology"},{"key":"B51","doi-asserted-by":"publisher","first-page":"104622","DOI":"10.1016\/j.neubiorev.2022.104622","article-title":"The cholinergic anti-inflammatory pathway in humans: state-of-the-art review and future directions","volume":"136","author":"Alen","year":"2022","journal-title":"Neurosci Biobehav Rev"},{"key":"B52","doi-asserted-by":"publisher","first-page":"3590389","DOI":"10.1155\/2020\/3590389","article-title":"Circulating inflammatory markers are inversely associated with heart rate variability measures in type 1 diabetes","volume":"2020","author":"Wegeberg","year":"2020","journal-title":"Mediators Inflamm"},{"key":"B53","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.bbi.2014.12.017","article-title":"Heart rate variability predicts levels of inflammatory markers: evidence for the vagal anti-inflammatory pathway","volume":"49","author":"Cooper","year":"2015","journal-title":"Brain Behav Immun"},{"key":"B54","doi-asserted-by":"publisher","first-page":"3331","DOI":"10.1007\/s00431-022-04534-4","article-title":"Introducing heart rate variability monitoring combined with biomarker screening into a level IV NICU: a prospective implementation study","volume":"181","author":"Kurul","year":"2022","journal-title":"Eur J Pediatr"},{"key":"B55","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.1161\/01.CIR.103.9.1250","article-title":"Positive and negative feedback mechanisms in the neural regulation of cardiovascular function in healthy and spinal cord\u2013injured humans","volume":"103","author":"Legramante","year":"2001","journal-title":"Circulation"},{"key":"B56","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1016\/j.jacc.2018.12.064","article-title":"Autonomic nervous system dysfunction: JACC focus seminar","volume":"73","author":"Goldberger","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"B57","doi-asserted-by":"publisher","first-page":"860198","DOI":"10.3389\/fcvm.2022.860198","article-title":"Long COVID-19 and postural orthostatic tachycardia syndrome- is dysautonomia to be blamed?","volume":"9","author":"Chadda","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B58","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1016\/j.jaccas.2021.01.009","article-title":"Long-haul post-COVID-19 symptoms presenting as a variant of postural orthostatic tachycardia syndrome: the Swedish experience","volume":"3","author":"Johansson","year":"2021","journal-title":"JACC Case Rep"},{"key":"B59","doi-asserted-by":"publisher","first-page":"778","DOI":"10.1002\/acn3.51557","article-title":"Prevalence and patterns of symptoms of dysautonomia in patients with long-COVID syndrome: a cross-sectional study","volume":"9","author":"Eldokla","year":"2022","journal-title":"Ann Clin Transl Neurol"},{"key":"B60","doi-asserted-by":"publisher","first-page":"1012668","DOI":"10.3389\/fneur.2022.1012668","article-title":"Characterization of autonomic symptom burden in long COVID: a global survey of 2,314 adults","volume":"13","author":"Larsen","year":"2022","journal-title":"Front Neurol"},{"key":"B61","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/j.ncl.2022.08.002","article-title":"Dysautonomia: diagnosis and management","volume":"41","author":"Hovaguimian","year":"2023","journal-title":"Neurol Clin"},{"key":"B62","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1093\/eurheartj\/ehac031","article-title":"Long COVID: post-acute sequelae of COVID-19 with a cardiovascular focus","volume":"43","author":"Raman","year":"2022","journal-title":"Eur Heart J"},{"key":"B63","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1007\/s10286-021-00798-2","article-title":"Long-COVID postural tachycardia syndrome: an American autonomic society statement","volume":"31","author":"Raj","year":"2021","journal-title":"Clin Auton Res"},{"key":"B64","doi-asserted-by":"publisher","first-page":"8251","DOI":"10.1038\/s41598-023-35086-8","article-title":"Parasympathetic autonomic dysfunction is more often evidenced than sympathetic autonomic dysfunction in fluctuating and polymorphic symptoms of \u201clong-COVID\u201d patients","volume":"13","author":"Zanin","year":"2023","journal-title":"Sci Rep"},{"key":"B65","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1007\/s11239-021-02549-6","article-title":"Autonomic dysfunction in SARS-COV-2 infection acute and long-term implications COVID-19 editor's Page series","volume":"52","author":"Becker","year":"2021","journal-title":"J Thromb Thrombolysis"},{"key":"B66","doi-asserted-by":"publisher","first-page":"4269","DOI":"10.1113\/JP281888","article-title":"COVID-19 is getting on our nerves: sympathetic neural activity and haemodynamics in young adults recovering from SARS-CoV-2","volume":"599","author":"Stute","year":"2021","journal-title":"J Physiol"},{"key":"B67","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1186\/s13063-022-07055-5","article-title":"Effects of physical training on functional, clinical, morphological, behavioural and psychosocial outcomes in post-COVID-19 infection: COVID-19 and REhabilitation study (CORE-study)-a study protocol for a randomised controlled clinical trial","volume":"24","author":"Delevatti","year":"2023","journal-title":"Trials"},{"key":"B68","doi-asserted-by":"publisher","first-page":"1937","DOI":"10.1017\/S003329172000207X","article-title":"Autonomic dysfunction in posttraumatic stress disorder indexed by heart rate variability: a meta-analysis","volume":"50","author":"Schneider","year":"2020","journal-title":"Psychol Med"},{"key":"B69","doi-asserted-by":"publisher","first-page":"e066044","DOI":"10.1136\/bmjopen-2022-066044","article-title":"HEART Rate variability biofeedback for long COVID symptoms (HEARTLOC): protocol for a feasibility study","volume":"12","author":"Corrado","year":"2022","journal-title":"BMJ Open"},{"key":"B70","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1016\/j.ijcard.2009.09.543","article-title":"The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors","volume":"141","author":"Thayer","year":"2010","journal-title":"Int J Cardiol"},{"key":"B71","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1161\/01.cir.0000047275.25795","article-title":"Short-term heart rate variability strongly predicts sudden cardiac death in chronic heart failure patients","volume":"107","author":"La Rovere","year":"2003","journal-title":"Circulation"},{"key":"B72","doi-asserted-by":"publisher","first-page":"752944","DOI":"10.3389\/fendo.2021.752944","article-title":"Autonomic imbalance increases the risk for non-alcoholic fatty liver disease","volume":"12","author":"Jung","year":"2021","journal-title":"Front Endocrinol"},{"key":"B73","doi-asserted-by":"publisher","first-page":"2457","DOI":"10.3390\/ijerph19042457","article-title":"Role of body mass and physical activity in autonomic function modulation on post-COVID-19 condition: an observational subanalysis of fit-COVID study","volume":"19","author":"Freire","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B74","doi-asserted-by":"publisher","first-page":"82","DOI":"10.2174\/157340313805076359","article-title":"Intracardiac origin of heart rate variability, pacemaker funny current and their possible association with critical illness","volume":"9","author":"Papaioannou","year":"2013","journal-title":"Curr Cardiol Rev"},{"key":"B75","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.eplepsyres.2018.08.002","article-title":"The analysis of circadian rhythm of heart rate variability in patients with drug-resistant epilepsy","volume":"146","author":"Yang","year":"2018","journal-title":"Epilepsy Res"},{"key":"B76","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1007\/s10072-022-06385-1","article-title":"Heart rate variability and fatigue in MS: two parallel pathways representing disseminated inflammatory processes?","volume":"44","author":"Garis","year":"2023","journal-title":"Neurol Sci"},{"key":"B77","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1111\/nmo.12817","article-title":"Vagal tone: effects on sensitivity, motility, and inflammation","volume":"28","author":"Bonaz","year":"2016","journal-title":"Neurogastroenterol Motil"},{"key":"B78","doi-asserted-by":"publisher","first-page":"862001","DOI":"10.3389\/fcvm.2022.862001","article-title":"Reduction of cardiac autonomic modulation and increased sympathetic activity by heart rate variability in patients with long COVID","volume":"9","author":"Marques","year":"2022","journal-title":"Front Cardiovasc Med"},{"key":"B79","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1007\/s00415-021-10735-y","article-title":"Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study","volume":"269","author":"Stella A","year":"2022","journal-title":"J Neurol"},{"key":"B80","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1007\/s00399-021-00780-5","article-title":"Autonomic dysfunction and heart rate variability with holter monitoring: a diagnostic look at autonomic regulation","volume":"32","author":"De Maria","year":"2021","journal-title":"Herzschrittmacherther Elektrophysiol"},{"key":"B81","doi-asserted-by":"publisher","first-page":"612782","DOI":"10.3389\/fspor.2021.612782","article-title":"Utilizing heart rate variability for coaching athletes during and after viral infection: a case report in an elite endurance athlete","volume":"3","author":"Hottenrott","year":"2021","journal-title":"Front Sports Act Living"},{"key":"B82","doi-asserted-by":"publisher","first-page":"e34","DOI":"10.1093\/milmed\/usaa405","article-title":"Heart rate variability as a possible predictive marker for acute inflammatory response in COVID-19 patients","volume":"186","author":"Hasty","year":"2021","journal-title":"Mil Med"},{"key":"B83","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.ipej.2022.01.004","article-title":"Heart rate variability as a marker of cardiovascular dysautonomia in post-COVID-19 syndrome using artificial intelligence","volume":"22","author":"Shah","year":"2022","journal-title":"Indian Pacing Electrophysiol J"},{"key":"B84","doi-asserted-by":"publisher","first-page":"830","DOI":"10.3390\/ijerph20010830","article-title":"Persistent increase of sympathetic activity in post-acute COVID-19 of paucisymptomatic healthcare workers","volume":"20","author":"Liviero","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"B85","doi-asserted-by":"publisher","first-page":"1035","DOI":"10.3390\/v14051035","article-title":"Impaired vagal activity in long-COVID-19 patients","volume":"14","author":"Acanfora","year":"2022","journal-title":"Viruses"},{"key":"B86","doi-asserted-by":"publisher","first-page":"100","DOI":"10.3390\/jcm12010100","article-title":"Cardiac autonomic function in long COVID-19 using heart rate variability: an observational cross-sectional study","volume":"12","author":"da Menezes Junior","year":"2022","journal-title":"J Clin Med"},{"key":"B87","doi-asserted-by":"publisher","first-page":"715","DOI":"10.1007\/s10840-022-01138-8","article-title":"Heart rate variability and cardiac autonomic functions in post-COVID period","volume":"63","author":"Asarcikli","year":"2022","journal-title":"J Interv Card Electrophysiol"},{"key":"B88","doi-asserted-by":"publisher","first-page":"ehac544.402","DOI":"10.1093\/eurheartj\/ehac544.402","article-title":"Impaired heart rate variability one and six months post acute COVID-19","volume":"43","author":"Lampsas","year":"2022","journal-title":"Eur Heart J"},{"key":"B89","doi-asserted-by":"publisher","first-page":"e12916","DOI":"10.1111\/anec.12916","article-title":"Altered cardiac autonomic function after recovery from COVID-19","volume":"27","author":"Kurto\u011flu","year":"2022","journal-title":"Ann Noninvasive Electrocardiol"},{"key":"B90","doi-asserted-by":"publisher","first-page":"2251","DOI":"10.3390\/ijerph20032251","article-title":"Autonomic function recovery and physical activity levels in post-COVID-19 young adults after immunization: an observational follow-up case-control study","volume":"20","author":"Freire","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"B91","doi-asserted-by":"publisher","first-page":"36","DOI":"10.26502\/ami.936500103","article-title":"Long COVID: complications, underlying mechanisms, and treatment strategies","volume":"7","author":"Zadeh","year":"2023","journal-title":"Arch Microbiol Immunol"},{"key":"B92","doi-asserted-by":"publisher","first-page":"393","DOI":"10.3390\/antiox12020393","article-title":"Potential of nano-antioxidants and nanomedicine for recovery from neurological disorders linked to long COVID syndrome","volume":"6","author":"Akanchise","year":"2023","journal-title":"Antioxidants"},{"key":"B93","doi-asserted-by":"publisher","first-page":"2465","DOI":"10.3390\/healthcare10122465","article-title":"Heart rate variability and chronotype in young adult men","volume":"10","author":"Vondrasek","year":"2022","journal-title":"Healthcare"},{"key":"B94","doi-asserted-by":"publisher","first-page":"1129459","DOI":"10.3389\/fimmu.2023.1129459","article-title":"Therapeutic trials for long COVID-19: a call to action from the interventions taskforce of the RECOVER initiative","volume":"14","author":"Bonilla","year":"2023","journal-title":"Front Immunol"},{"key":"B95","doi-asserted-by":"publisher","first-page":"1646","DOI":"10.3390\/biom12111646","article-title":"Possible application of melatonin in long COVID","volume":"12","author":"Cardinali","year":"2022","journal-title":"Biomolecules"},{"key":"B96","doi-asserted-by":"publisher","first-page":"e40256","DOI":"10.7759\/cureus.40256","article-title":"Evaluation of outpatients in the post-COVID-19 period in terms of autonomic dysfunction and silent ischemia","volume":"15","author":"Karakayal\u0131","year":"2023","journal-title":"Cureus"},{"key":"B97","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.3390\/healthcare11081095","article-title":"Long-term impact of COVID-19 on heart rate variability: a systematic review of observational studies","volume":"11","author":"Suh","year":"2023","journal-title":"Healthcare"},{"key":"B98","doi-asserted-by":"publisher","first-page":"101794","DOI":"10.1016\/j.berh.2022.101794","article-title":"Long COVID and rheumatology: clinical, diagnostic, and therapeutic implications","volume":"36","author":"Calabrese","year":"2022","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"B99","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1001\/archinte.166.2.247-a","article-title":"Heart rate variability in women","volume":"166","author":"Krantz","year":"2006","journal-title":"Arch Intern Med"},{"key":"B100","doi-asserted-by":"publisher","first-page":"103071","DOI":"10.1016\/j.autneu.2022.103071","article-title":"Investigating the possible mechanisms of autonomic dysfunction post-COVID-19","volume":"245","author":"Jammoul","year":"2023","journal-title":"Auton Neurosci"},{"key":"B101","doi-asserted-by":"publisher","first-page":"630038","DOI":"10.3389\/fphys.2021.630038","article-title":"Alteration of autonomic nervous system is associated with severity and outcomes in patients with COVID-19","volume":"12","author":"Pan","year":"2021","journal-title":"Front Physiol"},{"key":"B102","doi-asserted-by":"publisher","first-page":"1095249","DOI":"10.3389\/fmed.2022.1095249","article-title":"Cardiovascular and autonomic dysfunction in long-COVID syndrome and the potential role of non-invasive therapeutic strategies on cardiovascular outcomes","volume":"9","author":"Allendes","year":"2023","journal-title":"Front Med"},{"key":"B103","doi-asserted-by":"publisher","first-page":"105407","DOI":"10.1016\/j.compbiomed.2022.105407","article-title":"Heart rate variability for medical decision support systems: a review","volume":"145","author":"Faust","year":"2022","journal-title":"Comput Biol Med"},{"key":"B104","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1007\/s00395-022-00911-0","article-title":"Reverse re-modelling chronic heart failure by reinstating heart rate variability","volume":"117","author":"Shanks","year":"2022","journal-title":"Basic Res Cardiol"},{"key":"B105","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1016\/S2215-0366(22)00260-7","article-title":"Neurological and psychiatric risk trajectories after SARS-CoV-2 infection: an analysis of 2-year retrospective cohort studies including 1\u2008284\u2008437 patients","volume":"9","author":"Taquet","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"B106","doi-asserted-by":"publisher","first-page":"1117464","DOI":"10.3389\/fimmu.2023.1117464","article-title":"Long COVID: a review and proposed visualization of the complexity of long COVID","volume":"14","author":"Perumal","year":"2023","journal-title":"Front Immunol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1256512\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T07:13:23Z","timestamp":1693552403000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1256512\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,1]]},"references-count":106,"alternative-id":["10.3389\/fcvm.2023.1256512"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2023.1256512","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,1]]},"article-number":"1256512"}}