Journal Article

Exercise Ventilatory Inefficiency in Post-COVID-19 Syndrome: Insights from a Prospective Evaluation

Ladrón, Raquel, Recio-Platero, Amada, Fernández-Prieto, Laura, Baladrón, Carlos, García-Gómez, Mario, Iglesias-Echeverría, Carolina, de Vega-Sánchez, Blanca, Cusacovich, Iván, Andaluz-Ojeda, David, Disdier-Vicente, Carlos, Amat-Santos, Ignacio J., Carrasco-Moraleja, Manuel, Tobar, Javier, Aparisi, Álvaro, Sanz-Patiño, Esther, Calvo, Dolores, Marcos-Mangas, Marta, Sedano-Gutiérrez, Rosa, Hinojosa, Williams, Catalá, Pablo, Jaurrieta-Largo, Sofía, Uribarri, Aitor, Ybarra-Falcón, Cristina, San Román, J. Alberto

2021

Overview

Introduction: Coronavirus disease 2019 (COVID-19) is a systemic disease characterized by a disproportionate inflammatory response in the acute phase. This study sought to identify clinical sequelae and their potential mechanism. Methods: We conducted a prospective single-center study (NCT04689490) of previously hospitalized COVID-19 patients with and without dyspnea during mid-term follow-up. An outpatient group was also evaluated. They underwent serial testing with a cardiopulmonary exercise test (CPET), transthoracic echocardiogram, pulmonary lung test, six-minute walking test, serum biomarker analysis, and quality of life questionaries. Results: Patients with dyspnea (n = 41, 58.6%), compared with asymptomatic patients (n = 29, 41.4%), had a higher proportion of females (73.2 vs. 51.7%; p = 0.065) with comparable age and prevalence of cardiovascular risk factors. There were no significant differences in the transthoracic echocardiogram and pulmonary function test. Patients who complained of persistent dyspnea had a significant decline in predicted peak VO2 consumption (77.8 (64–92.5) vs. 99 (88–105); p < 0.00; p < 0.001), total distance in the six-minute walking test (535 (467–600) vs. 611 (550–650) meters; p = 0.001), and quality of life (KCCQ-23 60.1 ± 18.6 vs. 82.8 ± 11.3; p < 0.001). Additionally, abnormalities in CPET were suggestive of an impaired ventilatory efficiency (VE/VCO2 slope 32 (28.1–37.4) vs. 29.4 (26.9–31.4); p = 0.022) and high PETCO2 (34.5 (32–39) vs. 38 (36–40); p = 0.025). Interpretation: In this study, >50% of COVID-19 survivors present a symptomatic functional impairment irrespective of age or prior hospitalization. Our findings suggest a potential ventilation/perfusion mismatch or hyperventilation syndrome.

• Publisher: MDPI AG,MDPI
• Subject: Anaerobic threshold / Blood pressure / Carbon monoxide / Clinical medicine / Coronaviruses / COVID-19 / Dyspnea / Exercise / Fitness equipment / Heart / Immunoassay / ISO standards / Medical laboratories / Oxygen saturation / Patients / Quality of life / Severe acute respiratory syndrome coronavirus 2 / Spirometry / Virulence