tetano
Editor, Senior Moderator
EClinicalMedicine
. 2021 Oct 20;101159.
doi: 10.1016/j.eclinm.2021.101159. Online ahead of print.
Symptom Persistence Despite Improvement in Cardiopulmonary Health - Insights from longitudinal CMR, CPET and lung function testing post-COVID-19
Mark Philip Cassar[SUP] 1 2 [/SUP], Elizabeth M Tunnicliffe[SUP] 1 [/SUP], Nayia Petousi[SUP] 3 4 [/SUP], Adam J Lewandowski[SUP] 1 [/SUP], Cheng Xie[SUP] 5 6 [/SUP], Masliza Mahmod[SUP] 1 2 [/SUP], Azlan Helmy Abd Samat[SUP] 1 2 [/SUP], Rachael A Evans[SUP] 7 8 [/SUP], Christopher E Brightling[SUP] 7 8 [/SUP], Ling-Pei Ho[SUP] 9 4 [/SUP], Stefan K Piechnik[SUP] 1 [/SUP], Nick P Talbot[SUP] 10 4 [/SUP], David Holdsworth[SUP] 10 4 [/SUP], Vanessa M Ferreira[SUP] 1 2 [/SUP], Stefan Neubauer[SUP] 1 2 5 [/SUP], Betty Raman[SUP] 1 2 5 [/SUP]
Affiliations
Abstract
Background: The longitudinal trajectories of cardiopulmonary abnormalities and symptoms following infection with coronavirus disease (COVID-19) are unclear. We sought to describe their natural history in previously hospitalised patients, compare this with controls, and assess the relationship between symptoms and cardiopulmonary impairment at 6 months post-COVID-19.
Methods: Fifty-eight patients and thirty matched controls (single visit), recruited between 14[SUP]th[/SUP] March - 25[SUP]th[/SUP] May 2020, underwent symptom-questionnaires, cardiac and lung magnetic resonance imaging (CMR), cardiopulmonary exercise test (CPET), and spirometry at 3 months following COVID-19. Of them, forty-six patients returned for follow-up assessments at 6 months.
Findings: At 2-3 months, 83% of patients had at least one cardiopulmonary symptom versus 33% of controls. Patients and controls had comparable biventricular volumes and function. Native cardiac T[SUB]1[/SUB] (marker of fibroinflammation) and late gadolinium enhancement (LGE, marker of focal fibrosis) were increased in patients at 2-3 months. Sixty percent of patients had lung parenchymal abnormalities on CMR and 55% had reduced peak oxygen consumption (pV̇O[SUB]2[/SUB]) on CPET. By 6 months, 52% of patients remained symptomatic. On CMR, indexed right ventricular (RV) end-diastolic volume (-4·3 mls/m[SUP]2[/SUP], P=0·005) decreased and RV ejection fraction (+3·2%, P=0·0003) increased. Native T[SUB]1[/SUB] and LGE improved and was comparable to controls. Lung parenchymal abnormalities and peak V̇O[SUB]2[/SUB], although better, were abnormal in patients versus controls. 31% had reduced pV̇O[SUB]2[/SUB] secondary to symptomatic limitation and muscular impairment. Cardiopulmonary symptoms in patients did not associate with CMR, lung function, or CPET measures.
Interpretation: In patients, cardiopulmonary abnormalities improve over time, though some measures remain abnormal relative to controls. Persistent symptoms at 6 months post-COVID-19 did not associate with objective measures of cardiopulmonary health.
Funding: The authors' work was supported by the NIHR Oxford Biomedical Research Centre, Oxford British Heart Foundation (BHF) Centre of Research Excellence (RE/18/3/34214), United Kingdom Research Innovation and Wellcome Trust. This project is part of a tier 3 study (C-MORE) within the collaborative research programme entitled PHOSP-COVID Post-hospitalization COVID-19 study: a national consortium to understand and improve long-term health outcomes, funded by the Medical Research Council and Department of Health and Social Care/National Institute for Health Research Grant (MR/V027859/1) ISRCTN number 10980107.
Keywords: CMR; COVID-19; CPET; SARS-CoV-2; long COVID.
. 2021 Oct 20;101159.
doi: 10.1016/j.eclinm.2021.101159. Online ahead of print.
Symptom Persistence Despite Improvement in Cardiopulmonary Health - Insights from longitudinal CMR, CPET and lung function testing post-COVID-19
Mark Philip Cassar[SUP] 1 2 [/SUP], Elizabeth M Tunnicliffe[SUP] 1 [/SUP], Nayia Petousi[SUP] 3 4 [/SUP], Adam J Lewandowski[SUP] 1 [/SUP], Cheng Xie[SUP] 5 6 [/SUP], Masliza Mahmod[SUP] 1 2 [/SUP], Azlan Helmy Abd Samat[SUP] 1 2 [/SUP], Rachael A Evans[SUP] 7 8 [/SUP], Christopher E Brightling[SUP] 7 8 [/SUP], Ling-Pei Ho[SUP] 9 4 [/SUP], Stefan K Piechnik[SUP] 1 [/SUP], Nick P Talbot[SUP] 10 4 [/SUP], David Holdsworth[SUP] 10 4 [/SUP], Vanessa M Ferreira[SUP] 1 2 [/SUP], Stefan Neubauer[SUP] 1 2 5 [/SUP], Betty Raman[SUP] 1 2 5 [/SUP]
Affiliations
- PMID: 34693230
- PMCID: PMC8527025
- DOI: 10.1016/j.eclinm.2021.101159
Abstract
Background: The longitudinal trajectories of cardiopulmonary abnormalities and symptoms following infection with coronavirus disease (COVID-19) are unclear. We sought to describe their natural history in previously hospitalised patients, compare this with controls, and assess the relationship between symptoms and cardiopulmonary impairment at 6 months post-COVID-19.
Methods: Fifty-eight patients and thirty matched controls (single visit), recruited between 14[SUP]th[/SUP] March - 25[SUP]th[/SUP] May 2020, underwent symptom-questionnaires, cardiac and lung magnetic resonance imaging (CMR), cardiopulmonary exercise test (CPET), and spirometry at 3 months following COVID-19. Of them, forty-six patients returned for follow-up assessments at 6 months.
Findings: At 2-3 months, 83% of patients had at least one cardiopulmonary symptom versus 33% of controls. Patients and controls had comparable biventricular volumes and function. Native cardiac T[SUB]1[/SUB] (marker of fibroinflammation) and late gadolinium enhancement (LGE, marker of focal fibrosis) were increased in patients at 2-3 months. Sixty percent of patients had lung parenchymal abnormalities on CMR and 55% had reduced peak oxygen consumption (pV̇O[SUB]2[/SUB]) on CPET. By 6 months, 52% of patients remained symptomatic. On CMR, indexed right ventricular (RV) end-diastolic volume (-4·3 mls/m[SUP]2[/SUP], P=0·005) decreased and RV ejection fraction (+3·2%, P=0·0003) increased. Native T[SUB]1[/SUB] and LGE improved and was comparable to controls. Lung parenchymal abnormalities and peak V̇O[SUB]2[/SUB], although better, were abnormal in patients versus controls. 31% had reduced pV̇O[SUB]2[/SUB] secondary to symptomatic limitation and muscular impairment. Cardiopulmonary symptoms in patients did not associate with CMR, lung function, or CPET measures.
Interpretation: In patients, cardiopulmonary abnormalities improve over time, though some measures remain abnormal relative to controls. Persistent symptoms at 6 months post-COVID-19 did not associate with objective measures of cardiopulmonary health.
Funding: The authors' work was supported by the NIHR Oxford Biomedical Research Centre, Oxford British Heart Foundation (BHF) Centre of Research Excellence (RE/18/3/34214), United Kingdom Research Innovation and Wellcome Trust. This project is part of a tier 3 study (C-MORE) within the collaborative research programme entitled PHOSP-COVID Post-hospitalization COVID-19 study: a national consortium to understand and improve long-term health outcomes, funded by the Medical Research Council and Department of Health and Social Care/National Institute for Health Research Grant (MR/V027859/1) ISRCTN number 10980107.
Keywords: CMR; COVID-19; CPET; SARS-CoV-2; long COVID.