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. 2021 Dec;34(12):1273-1284.e9.
doi: 10.1016/j.echo.2021.08.022. Epub 2021 Sep 8.

Cardiorespiratory Abnormalities in Patients Recovering from Coronavirus Disease 2019

Yishay Szekely  1 , Yael Lichter  1 , Sapir Sadon  1 , Lior Lupu  1 , Philippe Taieb  1 , Ariel Banai  1 , Orly Sapir  1 , Yoav Granot  1 , Aviram Hochstadt  1 , Shirley Friedman  1 , Michal Laufer-Perl  1 , Shmuel Banai  1 , Yan Topilsky  2
Affiliations

Cardiorespiratory Abnormalities in Patients Recovering from Coronavirus Disease 2019

Yishay Szekely et al. J Am Soc Echocardiogr. 2021 Dec.

Abstract

Background: A large number of patients around the world are recovering from coronavirus disease 2019 (COVID-19); many of them report persistence of symptoms. The aim of this study was to test pulmonary, cardiovascular, and peripheral responses to exercise in patients recovering from COVID-19.

Methods: Patients who recovered from COVID-19 were prospectively evaluated using a combined anatomic and functional assessment. All patients underwent clinical examination, laboratory tests, and combined stress echocardiography and cardiopulmonary exercise testing. Left ventricular volumes, ejection fraction, stroke volume, heart rate, E/e' ratio, right ventricular function, oxygen consumption (Vo2), lung volumes, ventilatory efficiency, oxygen saturation, and muscle oxygen extraction were measured in all effort stages and compared with values in historical control subjects.

Results: A total of 71 patients were assessed 90.6 ± 26 days after the onset of COVID-19 symptoms. Only 23 (33%) were asymptomatic. The most common symptoms were fatigue (34%), muscle weakness or pain (27%), and dyspnea (22%). Vo2 was lower among post-COVID-19 patients compared with control subjects (P = .03, group-by-time interaction P = .007). Reduction in peak Vo2 was due to a combination of chronotropic incompetence (75% of post-COVID-19 patients vs 8% of control subjects, P < .0001) and an insufficient increase in stroke volume during exercise (P = .0007, group-by-time interaction P = .03). Stroke volume limitation was mostly explained by diminished increase in left ventricular end-diastolic volume (P = .10, group-by-time interaction P = .03) and insufficient increase in ejection fraction (P = .01, group-by-time interaction P = .01). Post-COVID-19 patients had higher peripheral oxygen extraction (P = .004) and did not have significantly different respiratory and gas exchange parameters compared with control subjects.

Conclusions: Patients recovering from COVID-19 have symptoms associated with objective reduction in peak Vo2. The mechanism of this reduction is complex and mainly involves a combination of attenuated heart rate and stroke volume reserve.

Keywords: COVID-19; Cardiopulmonary exercise test; Long COVID; Post-COVID; Stress echocardiography.

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Figures

Figure 1
Figure 1
Flowchart of study design.
Figure 2
Figure 2
Baseline, anaerobic threshold (AT), and maximal CPET and stress echocardiography in patients recovering from COVID-19 (red line) and historical control subjects (blue line) for LVEDV, SV, HR, cardiac output (CO), arteriovenous oxygen (A-Vo2) difference (AV diff), tidal volume (VT), and VE/Vco2 ratio (VECO2).
Supplemental Figure 1
Supplemental Figure 1
Baseline, anaerobic threshold (AT), and maximal CPET and stress echocardiography in patients recovering from COVID-19 with dyspnea (blue line) or without dyspnea (red line) for LVEDV, SV, HR, cardiac output (CO), A-Vo2 difference (AV diff), tidal volume (VT), and VE/Vco2 ratio. Note that patients with dyspnea had lower LVEDV, SV, HR, cardiac output, and VT and marginally higher VE/Vco2 ratio.
Supplemental Figure 2
Supplemental Figure 2
Baseline, anaerobic threshold (AT), and maximal CPET and stress echocardiography in patients recovering from COVID-19 with fatigue (blue line) or without fatigue (red line) for (A) LVEDV, (B) SV, (C) HR, (D) cardiac output (CO), (E) A-Vo2difference (AV diff), (F) tidal volume (VT), and (G) VE/Vco2 ratio. Note that patients with fatigue had lower HR, but otherwise there were no significant differences in all other parameters compared with patients without fatigue.
Supplemental Figure 3
Supplemental Figure 3
Baseline, anaerobic threshold (AT), and maximal CPET and stress echocardiography in patients recovering from COVID-19 with muscle weakness or pain (blue line) and without muscle weakness or pain (red line) for LVEDV, SV, HR, cardiac output (CO), A-Vo2 difference (AV diff), tidal volume (VT), and VE/Vco2 ratio. Note that patients with muscle weakness or pain did not have significantly different CPET parameters compared with patients without muscle weakness or pain.
See this image and copyright information in PMC

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