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Published on: August 24, 2019
Cardiopulmonary exercise testing in COVID-19 patients at 3 months follow-up
Piero Clavario1, Vincenzo De Marzo2, Roberta Lotti2
1Cardiac Rehabilitation Center of Genoa, Azienda Sanitaria Locale, ASL 3 Genovese, Genoa, Italy.
Insights
About one-third of Coronavirus Disease of 2019 (COVID-19) survivors experience functional limitations three months post-discharge. Muscular impairment is a primary cause, indicating a need for targeted rehabilitation and surveillance for high-risk patients.
Area of Science:
- Cardiology
- Pulmonology
- Rehabilitation Medicine
Background:
- Long-term effects of Coronavirus Disease of 2019 (COVID-19) require thorough investigation.
- Understanding functional capacity post-COVID-19 is crucial for patient recovery.
Purpose of the Study:
- To assess the functional capacity of COVID-19 survivors using cardiopulmonary exercise testing (CPET).
- To identify factors associated with CPET performance in survivors.
- To evaluate the safety and tolerability of CPET in this population.
Main Methods:
- Prospective enrollment of laboratory-confirmed COVID-19 patients post-hospital discharge.
- Comprehensive clinical evaluation including echocardiography, pulmonary function tests, and maximal strength measurements.
- Cardiopulmonary exercise testing (CPET) performed three months after discharge.
Main Results:
- Median percent-predicted peak oxygen uptake (%pVO2) was 88%, with 49.5% of patients below 85%.
- Among those with reduced %pVO2, causes included respiratory, cardiac, and non-cardiopulmonary factors.
- Forced expiratory volume, diffusing capacity, and leg strength were independently associated with peak oxygen uptake; 80% reported disabling symptoms.
Conclusions:
- Approximately one-third of COVID-19 survivors exhibit functional limitations three months post-discharge.
- Muscular impairment is a significant contributor to exercise limitation.
- Further research is needed to identify at-risk patients for targeted surveillance and rehabilitation.
Background:
Long-term effects of Coronavirus Disease of 2019 (COVID-19) are of utmost relevance. We aimed to determine: 1) the functional capacity of COVID-19 survivors by cardiopulmonary exercise testing (CPET); 2) the characteristics associated with cardiopulmonary exercise testing (CPET) performance; 3) the safety and tolerability of CPET.
Methods:
We prospectively enrolled consecutive patients with laboratory-confirmed COVID-19 from Azienda Sanitaria Locale 3, Genoa. Three months after hospital discharge a complete clinical evaluation, trans-thoracic echocardiography, CPET, pulmonary function tests, and dominant leg extension (DLE) maximal strength measurement were performed.
Results:
From the 225 patients discharged alive from March to November 2020, we excluded 12 incomplete/missing cases and 13 unable to perform CPET, leading to a final cohort of 200. Median percent-predicted peak oxygen uptake (%pVO2) was 88% (78.3-103.1). Ninety-nine (49.5%) patients had %pVO2 below, whereas 101 (50.5%) above the 85% predicted value. Among the 99 patients with reduced %pVO2, 61 (61%) had a normal anaerobic threshold: of these, 9(14.8%) had respiratory, 21(34.4%) cardiac, and 31(50.8%) non-cardiopulmonary reasons for exercise limitation. Inerestingly, 80% of patients experienced at least one disabling symtpom, not related to %pVO2 or functional capacity. Multivariate linear regression showed percent-predicted forced expiratory volume in one-second(β = 5.29,p = 0.023), percent-predicted diffusing capacity of lungs for carbon monoxide(β = 6.31,p = 0.001), and DLE maximal strength(β = 14.09,p = 0.008) to be independently associated with pVO2. No adverse event was reported during or after CPET, and no involved health professional developed COVID-19.
Conclusions:
At three months after discharge, about 1/3rd of COVID-19 survivors show functional limitations, mainly explained by muscular impairment, calling for future research to identify patients at higher risk of long-term effects that may benefit from careful surveillance and targeted rehabilitation.
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