ABSTRACT
Aim There are increasing reports of persisting exertional dyspnea several months after acute SARS-CoV-2 infection. The aim of this study was to evaluate pulmonary, cardiac, and functional capacity of SARS-CoV-2 survivors at 3 months after initial diagnosis by performing cardio-pulmonary exercise testing (CPET). Methods CPET was proposed to all patients who were treated both in and out of hospital settings at a tertiary university hospital at 3 months (±1 month) after the diagnosis of SARS-CoV-2 infection. Results A total of 114 patients were included in the study. The median age was 57 [48–66] and 30% were women. 91% required in-hospital treatment during the initial SARS-CoV-2 infection and 22% needed intensive care unit (ICU) admission. At 3-month follow-up, 51% of patients were still symptomatic and 40% reported dyspnea at exertion. During CPET, 71% of patients had impairment of exercise capacity, mostly due to muscle deconditioning (43%) and/or hyperventilation (16%). In multivariable-adjusted analysis, age (β=0.4, P=0.002), ICU stay (β=−10.27, P=0.017), endotracheal intubation and mechanical ventilation (β=−12.63, P=0.004) and total hospital length of stay (β=−0.24, P=0.009) were independently associated with % predicted oxygen uptake (peak VO2) (Fig. 1). Conclusion The majority of SARS-CoV-2 survivors had impairment of exercise capacity at 3 months after initial illness, mostly due to muscle deconditioning and exercise hyperventilation. Age and factors related to initial disease severity such as ICU stay and mechanical ventilation were predictive of worse performance during CPET.
ABSTRACT
Rationale: The long term evolution of Covid-19 pneumonia has still little been evaluated. We herein describe CT features that persist 3 months after Covid-19 symptom onset and correlate them to the extent of disease at diagnosis. Methods: Monocentric retrospective study including consecutive patients with Covid-19 confirmed by RT-PCR who presented to Bichat Hospital, Paris, France, between March and May 2020, and had a follow-up chest-CT 3 months later as part of their usual care. Chest CT analysis at 3 months evaluated ground-glass opacities (GGO, graded according to their extent and density), reticulations, bronchial distortion, honeycombing, band-like atelectasis and air trapping. The grade of persistent GGO and the presence of any sign suggestive of fibrosis were correlated to the extent of disease at presentation.Results;Any residual opacity was observed in 99/142 patients (70%). GGO, band-like atelectasis and reticulations were the most frequent findings, in 87/142 (61%), 53/142 (37%) and 40/142 (28%) patients, respectively. Signs that may suggest a fibrosing evolution, including bronchial distortion and distorted reticulations, were observed in 17/142 patients (12%), whereas no case showed honeycombing. Air trapping was present in 12 out of 80 patients (15%) who had an expiratory CT. The grade of GGO and the presence of reticulations at 3 months were highly correlated to the extent of disease at presentation (p<0.0001 and p=0.020, Kruskall Wallis) but signs suggestive of fibrosis were not (p=0.15)Conclusion: Residual opacities are frequent 3 months after Covid-19 pneumonia onset, chest CT mostly showing GGO, band-like atelectasis and reticulations. Signs that may suggest a fibrosing evolution are observed in only 12% of patients.