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Comparative Study
. 2024 Mar-Apr:83:71-76.
doi: 10.1016/j.pcad.2023.05.005. Epub 2023 May 19.

Cardiopulmonary testing in long COVID-19 versus non-COVID-19 patients with undifferentiated Dyspnea on exertion

Alejandra Meza Contreras  1 , Darrell B Newman  1 , Lucio Cappelloni  1 , Alexander S Niven  2 , Michael R Mueller  3 , Ravindra Ganesh  3 , Ray W Squires  1 , Amanda R Bonikowske  1 , Thomas G Allison  4
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Comparative Study

Cardiopulmonary testing in long COVID-19 versus non-COVID-19 patients with undifferentiated Dyspnea on exertion

Alejandra Meza Contreras et al. Prog Cardiovasc Dis. 2024 Mar-Apr.

Abstract

Background: Dyspnea and fatigue are characteristics of long SARS-CoV-2 (COVID)-19. Cardiopulmonary exercise testing (CPET) can be used to better evaluate such patients.

Research question: How significantly and by what mechanisms is exercise capacity impaired in patients with long COVID who are coming to a specialized clinic for evaluation?

Study design and methods: We performed a cohort study using the Mayo Clinic exercise testing database. Subjects included consecutive long COVID patients without prior history of heart or lung disease sent from the Post-COVID Care Clinic for CPET. They were compared to a historical group of non-COVID patients with undifferentiated dyspnea also without known cardiac or pulmonary disease. Statistical comparisons were performed by t-test or Pearson's chi2 test controlling for age, sex, and beta blocker use where appropriate.

Results: We found 77 patients with long COVID and 766 control patients. Long COVID patients were younger (47 ± 15 vs 50 ± 10 years, P < .01) and more likely female (70% vs 58%, P < .01). The most prominent difference on CPETs was lower percent predicted peak V̇O2 (73 ± 18 vs 85 ± 23%, p < .0001). Autonomic abnormalities (resting tachycardia, CNS changes, low systolic blood pressure) were seen during CPET more commonly in long COVID patients (34 vs 23%, P < .04), while mild pulmonary abnormalities (mild desaturation, limited breathing reserve, elevated V̇E/V̇CO2) during CPET were similar (19% in both groups) with only 1 long COVID patient showing severe impairment.

Interpretation: We identified severe exercise limitation among long COVID patients. Young women may be at higher risk for these complications. Though mild pulmonary and autonomic impairment were common in long COVID patients, marked limitations were uncommon. We hope our observations help to untangle the physiologic abnormalities responsible for the symptomatology of long COVID.

Keywords: Cardiopulmonary exercise testing; Long COVID-19; autonomic abnormalities; dyspnea; fatigue.

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Conflict of interest statement

Declaration of Competing Interest The authors report no conflicts of interest in this work.

Figures

Fig. 1
Fig. 1
Comparison of percent predicted peak V̇O2 in long COVID patients versus Control subjects.
Fig. 2
Fig. 2
Symptoms during CPET in long COVID patients versus Control subjects.
See this image and copyright information in PMC

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