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- Title:
Cardiopulmonary exercise testing excludes significant disease in patients recovering from COVID-19.
- Document type:
- Article; Journal Article
- Author(s):
- Holdsworth, D A; Barker-Davies, R M; Chamley, R R; O'Sullivan, O; Ladlow, P; May, S; Houston, A D; Mulae, J; Xie, C; Cranley, M; Sellon, E; Naylor, J; Halle, M; Parati, G; Davos, C; Rider, O J; Bennett, A B; Nicol, E D
- Abstract:
- OBJECTIVE: Post-COVID-19 syndrome presents a health and economic challenge affecting ~10% of patients recovering from COVID-19. Accurate assessment of patients with post-COVID-19 syndrome is complicated by health anxiety and coincident symptomatic autonomic dysfunction. We sought to determine whether either symptoms or objective cardiopulmonary exercise testing could predict clinically significant findings. METHODS: 113 consecutive military patients were assessed in a comprehensive clinical pathway. This included symptom reporting, history, examination, spirometry, echocardiography and cardiopulmonary exercise testing (CPET) in all, with chest CT, dual-energy CT pulmonary angiography and cardiac MRI where indicated. Symptoms, CPET findings and presence/absence of significant pathology were reviewed. Data were analysed to identify diagnostic strategies that may be used to exclude significant disease. RESULTS: 7/113 (6%) patients had clinically significant disease adjudicated by cardiothoracic multidisciplinary team (MDT). These patients had reduced fitness (V̇O2 26.7 (±5.1) vs 34.6 (±7.0) mL/kg/min; p=0.002) and functional capacity (peak power 200 (±36) vs 247 (±55) W; p=0.026) compared with those without significant disease. Simple CPET criteria (oxygen uptake (V̇O2) >100% predicted and minute ventilation (VE)/carbon dioxide elimination (V̇CO2) slope <30.0 or VE/V̇CO2 slope <35.0 in isolation) excluded significant disease with sensitivity and specificity of 86% and 83%, respectively (area under the receiver operating characteristic curve (AUC) 0.89). The addition of capillary blood gases to estimate alveolar-arterial gradient improved diagnostic performance to 100% sensitivity and 78% specificity (AUC 0.92). Symptoms and spirometry did not discriminate significant disease. CONCLUSIONS: In a population recovering from SARS-CoV-2, there is reassuringly little organ pathology. CPET and functional capacity testing, but not reported symptoms, permit the exclusion of clinically significant disease.
- Journal title abbreviation:
- BMJ Mil Health
- Year:
- 2024
- Journal volume:
- 170
- Journal issue:
- 4
- Pages contribution:
- 308-314
- Fulltext / DOI:
- doi:10.1136/military-2022-002193
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/36442889
- Print-ISSN:
- 2633-3767
- TUM Institution:
- Poliklinik für Präventive Sportmedizin und Sportkardiologie (Prof. Halle)
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