Long COVID: Distinction between Organ Damage and Deconditioning

Area of Science:

• Cardiology
• Pulmonology
• Infectious Diseases

Background:

• Long COVID syndrome presents with diverse sequelae, even after mild initial illness.
• Evidence on organic consequences and diagnostic standards for long COVID remains limited.
• This study addresses the need for an efficient diagnostic strategy for post-COVID cardiopulmonary symptoms.

Purpose of the Study:

• To evaluate the efficiency of a stepwise diagnostic approach for diagnosing long COVID syndrome.
• To determine the frequency and nature of cardiopulmonary sequelae in recovered COVID-19 patients.
• To differentiate between organic damage and functional complaints in long COVID.

Main Methods:

• A three-step diagnostic workup was implemented for 231 patients with long COVID symptoms.
• Initial assessment included broad tests like blood work and body plethysmography.
• Advanced diagnostics involved cardiopulmonary exercise testing (CPET) and cardiac MRI (CMR), with a tailored third step.

Main Results:

• 34.6% of patients showed suspicious findings in the initial assessment, warranting further investigation.
• Among 36 patients undergoing CPET and CMR, 44.4% exhibited pathological findings.
• Cardiopulmonary sequelae were identified in patients regardless of initial COVID-19 severity.

Conclusions:

• A structured, stepwise diagnostic pathway for long COVID syndrome is practical and resource-efficient.
• This approach enables accurate diagnosis of manifest organ damage.
• The diagnostic strategy effectively distinguishes between organic cardiopulmonary sequelae and functional long COVID complaints.