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. 2022 Jul 8;159(1):6-11.
doi: 10.1016/j.medcle.2021.07.023. Epub 2022 Jul 5.

Cardiopulmonary Exercise Testing in Patients with Post-COVID-19 Syndrome

Leandro Barbagelata  1 , Walter Masson  1 , Diego Iglesias  1 , Ezequiel Lillo  1 , Juan Francisco Migone  1 , Maria Laura Orazi  2 , Joaquin Maritano Furcada  2
Affiliations

Cardiopulmonary Exercise Testing in Patients with Post-COVID-19 Syndrome

Leandro Barbagelata et al. Med Clin (Engl Ed). .

Abstract
in English, Spanish

Background and aim: Several reports have shown the persistence of long term symptoms after the initial COVID-19 infection (post-COVID-19 syndrome). The objective of this study was to analyze the characteristics of cardiopulmonary exercise testing (CPET) performed in patients with a history of COVID-19, comparing subjects according to the presence of post-COVID-19 syndrome.

Methods: A cross-sectional study was performed. Consecutive patients >18 years with history of SARS-CoV-2 infection confirmed by polymerase chain reaction test and a CPET performed between 45 and 120 days after the viral episode were included. The association between variables related to CPET and post-COVID-19 syndrome was assessed using univariate and multivariate analysis.

Results: A total of 200 patients (mean age 48.8 ± 14.3 years, 51% men) were included. Patients with post-COVID-19 syndrome showed significantly lower main peak VO2 (25.8 ± 8.1 mL/min/kg vs. 28.8 ± 9.6 mL/min/kg, p = 0.017) as compared to asymptomatic subjects. Moreover, patients with post-COVID-19 syndrome developed symptoms more frequently during CPET (52.7% vs. 13.7%, p < 0.001) and were less likely to reach the anaerobic threshold (50.9% vs. 72.7%, p = 0.002) when compared to asymptomatic subjects. These findings were not modified when adjusting for confounders.

Conclusion: Our data suggest that post-COVID-19 syndrome was associated with less peak VO2, a lower probability of achieving the anaerobic threshold and a higher probability of presenting symptoms during the CPET. Future studies are needed to determine if these abnormalities during CPET would have prognostic value.

Antecedentes y objetivo: Varios informes han demostrado la persistencia de síntomas a largo plazo luego de la infección inicial por COVID-19 (síndrome post-COVID-19). El objetivo de este estudio fue analizar las características de la prueba de esfuerzo cardiopulmonar (PECP) realizada en pacientes con antecedentes de infección por COVID-19, comparando sujetos según la presencia de síndrome post-COVID-19.

Métodos: se realizó un estudio transversal. Se incluyeron pacientes consecutivos >18 años con antecedentes de infección por SARS-CoV-2 confirmada por la prueba de reacción en cadena de la polimerasa y una PECP realizada entre 45 y 120 días luego del episodio viral. Se evaluó la asociación entre variables relacionadas con la PECP y síndrome post-COVID-19 mediante análisis univariante y multivariado.

Resultados: Se incluyeron 200 pacientes (edad media 48,8 ± 14,3 años, 51% hombres). Los pacientes con síndrome post-COVID-19 mostraron un VO2 pico significativamente menor (25,8 ± 8,1 mL/min/kg frente a 28,8 ± 9,6 mL/min/kg, p = 0,017) en comparación con los sujetos asintomáticos. Además, los pacientes con síndrome post-COVID-19 desarrollaron síntomas con mayor frecuencia durante la PECP (52,7% vs. 13,7%, p < 0,001) y tenían menos probabilidades de alcanzar el umbral anaeróbico (50,9% vs. 72,7%, p = 0,002) en comparación con sujetos asintomáticos. Estos hallazgos no se modificaron al ajustar por factores de confusión.

Conclusión: Nuestros datos sugieren que el síndrome post-COVID-19 se asoció con un menor VO2 pico, una menor probabilidad de alcanzar el umbral anaeróbico y una mayor probabilidad de presentar síntomas durante la PECP. Se necesitan estudios futuros para determinar si estas anomalías durante la PECP tendrían valor pronóstico.

Keywords: Anaerobic threshold; COVID-19; Cardiopulmonary exercise testing; Peak VO2; Post-COVID-19 syndrome.

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