tetano
Editor, Senior Moderator
Chest
. 2021 Aug 10;S0012-3692(21)03635-7.
doi: 10.1016/j.chest.2021.08.010. Online ahead of print.
Persistent Exertional Intolerance after COVID-19: Insights from Invasive Cardiopulmonary Exercise Testing
Inderjit Singh[SUP] 1 [/SUP], Phillip Joseph[SUP] 2 [/SUP], Paul M Heerdt[SUP] 3 [/SUP], Marjorie Cullinan[SUP] 4 [/SUP], Denyse D Lutchmansingh[SUP] 2 [/SUP], Mridu Gulati[SUP] 2 [/SUP], Jennifer D Possick[SUP] 2 [/SUP], David M Systrom[SUP] 5 [/SUP], Aaron B Waxman[SUP] 5 [/SUP]
Affiliations
Abstract
Background: Some Coronavirus disease 2019 (COVID-19) patients who have recovered from their acute infection after experiencing only mild symptoms continue to exhibit persistent exertional limitation that is often unexplained by conventional investigative studies.
Research question: What is the patho-physiological mechanism of exercise intolerance that underlies the post-COVID-19 long haul syndrome following COVID-19 in patients without cardio-pulmonary disease?
Study design and methods: This study examined the systemic and pulmonary hemodynamics, ventilation, and gas exchange in 10 post-COVID-19 patients without cardio-pulmonary disease during invasive cardiopulmonary exercise testing (iCPET) and compared the results to 10 age- and sex matched controls. These data were then used to define potential reasons for exertional limitation in the post-COVID-19 cohort.
Results: Post-COVID-19 patients exhibited markedly reduced peak exercise aerobic capacity (VO[SUB]2[/SUB]) compared to controls (70±11%predicted vs. 131±45%predicted; p<0.0001). This reduction in peak VO[SUB]2[/SUB] was associated with impaired systemic oxygen extraction (i.e., narrow CaVO[SUB]2[/SUB]/CaO[SUB]2[/SUB]) compared to controls (0.49±0.1 vs. 0.78±0.1, p<0.0001) despite a preserved peak cardiac index (7.8±3.1 vs. 8.4±2.3 L/min, p>0.05). Additionally, post-COVID-19 patients demonstrated greater ventilatory inefficiency (i.e., abnormal VE/VCO[SUB]2[/SUB] slope: 35±5 vs. 27±5, p=0.01) compared to controls without an increase in dead space ventilation.
Interpretation: Post-COVID-19 patients without cardiopulmonary disease demonstrate a marked reduction in peak VO[SUB]2[/SUB] from a peripheral rather than a central cardiac limit along with an exaggerated hyper-ventilatory response during exercise.
Keywords: COVID-19; cardiopulmonary exercise test; hemodynamics; iCPET; long haulers; post-COVID-19 syndrome.
. 2021 Aug 10;S0012-3692(21)03635-7.
doi: 10.1016/j.chest.2021.08.010. Online ahead of print.
Persistent Exertional Intolerance after COVID-19: Insights from Invasive Cardiopulmonary Exercise Testing
Inderjit Singh[SUP] 1 [/SUP], Phillip Joseph[SUP] 2 [/SUP], Paul M Heerdt[SUP] 3 [/SUP], Marjorie Cullinan[SUP] 4 [/SUP], Denyse D Lutchmansingh[SUP] 2 [/SUP], Mridu Gulati[SUP] 2 [/SUP], Jennifer D Possick[SUP] 2 [/SUP], David M Systrom[SUP] 5 [/SUP], Aaron B Waxman[SUP] 5 [/SUP]
Affiliations
- PMID: 34389297
- DOI: 10.1016/j.chest.2021.08.010
Abstract
Background: Some Coronavirus disease 2019 (COVID-19) patients who have recovered from their acute infection after experiencing only mild symptoms continue to exhibit persistent exertional limitation that is often unexplained by conventional investigative studies.
Research question: What is the patho-physiological mechanism of exercise intolerance that underlies the post-COVID-19 long haul syndrome following COVID-19 in patients without cardio-pulmonary disease?
Study design and methods: This study examined the systemic and pulmonary hemodynamics, ventilation, and gas exchange in 10 post-COVID-19 patients without cardio-pulmonary disease during invasive cardiopulmonary exercise testing (iCPET) and compared the results to 10 age- and sex matched controls. These data were then used to define potential reasons for exertional limitation in the post-COVID-19 cohort.
Results: Post-COVID-19 patients exhibited markedly reduced peak exercise aerobic capacity (VO[SUB]2[/SUB]) compared to controls (70±11%predicted vs. 131±45%predicted; p<0.0001). This reduction in peak VO[SUB]2[/SUB] was associated with impaired systemic oxygen extraction (i.e., narrow CaVO[SUB]2[/SUB]/CaO[SUB]2[/SUB]) compared to controls (0.49±0.1 vs. 0.78±0.1, p<0.0001) despite a preserved peak cardiac index (7.8±3.1 vs. 8.4±2.3 L/min, p>0.05). Additionally, post-COVID-19 patients demonstrated greater ventilatory inefficiency (i.e., abnormal VE/VCO[SUB]2[/SUB] slope: 35±5 vs. 27±5, p=0.01) compared to controls without an increase in dead space ventilation.
Interpretation: Post-COVID-19 patients without cardiopulmonary disease demonstrate a marked reduction in peak VO[SUB]2[/SUB] from a peripheral rather than a central cardiac limit along with an exaggerated hyper-ventilatory response during exercise.
Keywords: COVID-19; cardiopulmonary exercise test; hemodynamics; iCPET; long haulers; post-COVID-19 syndrome.