Differential cardiopulmonary haemodynamic phenotypes in PASC-related exercise intolerance

Area of Science:

• Cardiology
• Pulmonology
• Exercise Physiology

Background:

• Post-acute sequelae of COVID-19 (PASC) commonly present with exertional intolerance.
• Understanding the underlying hemodynamic abnormalities is crucial for effective management.

Purpose of the Study:

• To characterize invasive hemodynamic abnormalities in PASC-related exertional intolerance.
• To investigate the role of heart failure with preserved ejection fraction (HFpEF) and obesity in PASC exertional limitations.

Main Methods:

• Invasive cardiopulmonary exercise testing (iCPET) and right heart catheterization were performed on 55 PASC patients.
• Comparison with an obese non-PASC control group was used to assess obesity's contribution.

Main Results:

• 75% of PASC patients showed impaired peak oxygen extraction (pEO2) with supranormal cardiac output.
• Approximately 25% had central cardiopulmonary pathology, including HFpEF or pulmonary hypertension (PH).
• PASC patients with HFpEF exhibited impaired pEO2 and compensated PH, with obesity being a significant factor.

Conclusions:

• Impaired pEO2 is a key factor in PASC exertional intolerance, often unexplained by standard tests.
• A distinct HFpEF phenotype with peripheral exercise limitation is prevalent in PASC.
• Supervised rehabilitation did not significantly alter impaired pEO2 in PASC patients.