tetano
Editor, Senior Moderator
ERJ Open Res
. 2023 May 22;9(3):00538-2022.
doi: 10.1183/23120541.00538-2022. eCollection 2023 May. Exercise intolerance in post-coronavirus disease 2019 survivors after hospitalisation
Mariana L Lafetá[SUP] 1 [/SUP], Vitor C Souza[SUP] 1 [/SUP], Thaís C F Menezes[SUP] 1 [/SUP], Carlos G Y Verrastro[SUP] 2 [/SUP], Frederico J Mancuso[SUP] 3 [/SUP], André Luis P Albuquerque[SUP] 4 5 [/SUP], Suzana E Tanni[SUP] 6 [/SUP], Meyer Izbicki[SUP] 1 [/SUP], Júlio P Carlstron[SUP] 1 [/SUP], Luiz Eduardo Nery[SUP] 1 [/SUP], Rudolf K F Oliveira[SUP] 1 [/SUP], Priscila A Sperandio[SUP] 1 [/SUP], Eloara V M Ferreira[SUP] 1 [/SUP]
Affiliations
Rationale: Post-coronavirus disease 2019 (COVID-19) survivors frequently have dyspnoea that can lead to exercise intolerance and lower quality of life. Despite recent advances, the pathophysiological mechanisms of exercise intolerance in the post-COVID-19 patients remain incompletely characterised. The objectives of the present study were to clarify the mechanisms of exercise intolerance in post-COVID-19 survivors after hospitalisation.
Methods: This prospective study evaluated consecutive patients previously hospitalised due to moderate-to-severe/critical COVID-19. Within mean±sd 90±10 days of onset of acute COVID-19 symptoms, patients underwent a comprehensive cardiopulmonary assessment, including cardiopulmonary exercise testing with earlobe arterialised capillary blood gas analysis.
Measurements and main results: 87 patients were evaluated; mean±sd peak oxygen consumption was 19.5±5.0 mL·kg[SUP]-1[/SUP]·min[SUP]-1[/SUP], and the tertiles were ≤17.0, 17.1-22.2 and ≥22.3 mL·kg[SUP]-1[/SUP]·min[SUP]-1[/SUP]. Hospitalisation severity was similar among the three groups; however, at the follow-up visit, patients with peak oxygen consumption ≤17.0 mL·kg[SUP]-1[/SUP]·min[SUP]-1[/SUP] reported a greater sensation of dyspnoea, along with indices of impaired pulmonary function, and abnormal ventilatory, gas-exchange and metabolic responses during exercise compared to patients with peak oxygen consumption >17 mL·kg[SUP]-1[/SUP]·min[SUP]-1[/SUP]. By multivariate logistic regression analysis (receiver operating characteristic curve analysis) adjusted for age, sex and prior pulmonary embolism, a peak dead space fraction of tidal volume ≥29 and a resting forced vital capacity ≤80% predicted were independent predictors of reduced peak oxygen consumption.
Conclusions: Exercise intolerance in the post-COVID-19 survivors was related to a high dead space fraction of tidal volume at peak exercise and a decreased resting forced vital capacity, suggesting that both pulmonary microcirculation injury and ventilatory impairment could influence aerobic capacity in this patient population.
. 2023 May 22;9(3):00538-2022.
doi: 10.1183/23120541.00538-2022. eCollection 2023 May. Exercise intolerance in post-coronavirus disease 2019 survivors after hospitalisation
Mariana L Lafetá[SUP] 1 [/SUP], Vitor C Souza[SUP] 1 [/SUP], Thaís C F Menezes[SUP] 1 [/SUP], Carlos G Y Verrastro[SUP] 2 [/SUP], Frederico J Mancuso[SUP] 3 [/SUP], André Luis P Albuquerque[SUP] 4 5 [/SUP], Suzana E Tanni[SUP] 6 [/SUP], Meyer Izbicki[SUP] 1 [/SUP], Júlio P Carlstron[SUP] 1 [/SUP], Luiz Eduardo Nery[SUP] 1 [/SUP], Rudolf K F Oliveira[SUP] 1 [/SUP], Priscila A Sperandio[SUP] 1 [/SUP], Eloara V M Ferreira[SUP] 1 [/SUP]
Affiliations
- PMID: 37228270
- PMCID: PMC10204824
- DOI: 10.1183/23120541.00538-2022
Rationale: Post-coronavirus disease 2019 (COVID-19) survivors frequently have dyspnoea that can lead to exercise intolerance and lower quality of life. Despite recent advances, the pathophysiological mechanisms of exercise intolerance in the post-COVID-19 patients remain incompletely characterised. The objectives of the present study were to clarify the mechanisms of exercise intolerance in post-COVID-19 survivors after hospitalisation.
Methods: This prospective study evaluated consecutive patients previously hospitalised due to moderate-to-severe/critical COVID-19. Within mean±sd 90±10 days of onset of acute COVID-19 symptoms, patients underwent a comprehensive cardiopulmonary assessment, including cardiopulmonary exercise testing with earlobe arterialised capillary blood gas analysis.
Measurements and main results: 87 patients were evaluated; mean±sd peak oxygen consumption was 19.5±5.0 mL·kg[SUP]-1[/SUP]·min[SUP]-1[/SUP], and the tertiles were ≤17.0, 17.1-22.2 and ≥22.3 mL·kg[SUP]-1[/SUP]·min[SUP]-1[/SUP]. Hospitalisation severity was similar among the three groups; however, at the follow-up visit, patients with peak oxygen consumption ≤17.0 mL·kg[SUP]-1[/SUP]·min[SUP]-1[/SUP] reported a greater sensation of dyspnoea, along with indices of impaired pulmonary function, and abnormal ventilatory, gas-exchange and metabolic responses during exercise compared to patients with peak oxygen consumption >17 mL·kg[SUP]-1[/SUP]·min[SUP]-1[/SUP]. By multivariate logistic regression analysis (receiver operating characteristic curve analysis) adjusted for age, sex and prior pulmonary embolism, a peak dead space fraction of tidal volume ≥29 and a resting forced vital capacity ≤80% predicted were independent predictors of reduced peak oxygen consumption.
Conclusions: Exercise intolerance in the post-COVID-19 survivors was related to a high dead space fraction of tidal volume at peak exercise and a decreased resting forced vital capacity, suggesting that both pulmonary microcirculation injury and ventilatory impairment could influence aerobic capacity in this patient population.