Ventilation dynamics using a portable device coupled to the six-minute walk test in people with long-COVID syndrome: a preliminary study.

OBJECTIVE: To investigated the dynamic ventilatory responses and their influence on functional exercise capacity in patients with long-COVID-19 syndrome (LCS). RESULTS: Sixteen LCS patients were subjected to resting lung function (spirometry and respiratory oscillometry-RO) and cardiopulmonary performance to exercise (Spiropalm®-equipped six-minute walk test-6MWT and cardiopulmonary exercise test-CPX). At rest, spirometry showed a normal, restrictive and obstructive pattern in 87.5%, 6.25% and 6.25% of participants, respectively. At rest, RO showed increased resonance frequency, increased integrated low-frequency reactance and increased difference between resistance at 4-20 Hz (R4-R20) in 43.7%, 50%, and 31.2% of participants, respectively. The median of six-minute walking distance (DTC6) was 434 (386-478) m, which corresponds to a value of 83% (78-97%) of predicted. Dynamic hyperinflation (DH) and reduced breathing reserve (BR) were detected in 62.5% and 12.5% of participants, respectively. At CPX, the median peak oxygen uptake (VO2peak) was 19 (14-37) ml/kg/min. There was a significant correlation of 6MWD with both R4-R20 (rs=-0.499, P = 0.039) and VO2peak (rs=0.628, P = 0.009). Our results indicate that DH and low BR are contributors to poor exercise performance, which is associated with peripheral airway disease. These are promising results considering that they were achieved with simple, portable ventilatory and metabolic systems.

How did the COVID-19 pandemic affect SPECT myocardial perfusion scans?

Objectives: The aim of this study is to evaluate the effect of the COVID-19 pandemic on myocardial perfusion scans (MPS) during the COVID-19 pandemic period. Method(s): We respectively reviewed single photon emission computed tomography myocardial perfusion scans (SPECT-MPS) performed between June and September 2020 during the COVID-19 pandemic at the Nuclear Medicine Research Center at Mashhad University of Medical Sciences. The findings of stress SPECT-MPS studies acquired in the corresponding months of 2019 were also evaluated for direct comparison. Result(s): In COVID-19 pandemic compared to period prior to the pandemic, no difference was observed in terms of age range of patients under study or their cardiovascular risk factors, except smoking which underwent a significant increase during the COVID-19 pandemic ( 19% vs. 13% , p = 0.009). While the number of patients with non-angina (19% vs. 31%, p = 0.000) or typical (11% vs. 19%, p = 0.000) chest pain significantly decreased during the COVID-19 pandemic, atypical (42% vs. 25%, p = 0.000) chest pain cases showed an increasing number. By considering pretest probability of the patients (high, intermediate and low/very low), during the COVID-19 period, cases of high pretest probability decreased (6% vs. 18%, p = 0.000) and intermediate pretest probability patients also increased (64% vs. 55%, p = 0.005) while low/very low pretest probability cases showed no changes between the two periods. All types of MPS stress tests in the COVID-19 period were pharmacological compared to exercise stress test. No statistically significant difference on the myocardial ischemia or cardiomyopathy between patients between the two periods was observed. Summed stress score (SSS) and summed rest score (SRS) was similar over the two periods,while summed difference score (SDS) significantly increased over the course of COVID-19, confirming a non- increasing pattern of myocardial ischemia. Conclusion(s): Previous research underscores the fact that the number of stress SPECT-MPS studies was significantly reduced during the COVID-19 pandemic compared to the corresponding months prior to the pandemic [1, 2]. Our study concluded that all types of MPS stress tests in the COVID-19 period were pharmacological. This is due to the fact that all related recommendations published in the literature [3] highlighted the avoidance of exercise stress tests during the COVID-19 pandemic to reduce the risk of droplet exposure. During the COVID-19 pandemic, patients in two ends of the spectrum (e.g., non-angina & typical chest pain) were referred less for MPS. However, patients in the middle of the spectrum (e.g., atypical chest pain) underwentMPS less frequently. Myocardial ischemia and cardiomyopathy were not decreased or increased in patients over the COVID-19 period.

One-minute-sit-to-stand-test elicits less desaturation than 6MWT in advanced respiratory disease

Introduction: During the COVID-19 pandemic pulmonary rehabilitation moved to a telehealth platform and the 1-min sit-to-stand test (1minSTS) was often used instead of the 6-min walk test (6MWT) to evaluate functional exercise capacity. We sought to determine;(i) the extent to which the six-minute walk distance (6MWD) could be estimated from the number of repetitions achieved during the 1minSTS and, (ii) agreement in cardiorespiratory responses elicited collected during the tests. Method(s): Data were extracted from medical records on all people who attended the advanced lung disease service at Fiona Stanley Hospital between September 2021 and January 2022. Pulse rate and oxygen saturation (SpO 2) were measured continuously during both tests using a pulse oximeter. Symptoms were quantified using the Borg scale (0 to 10). Result(s): Data were available on 80 participants (43 males;age 64 +/- 10 years;FEV 1 1.65 +/- 0.77 L). Compared with the 6MWT, the 1minSTS resulted in a higher nadir (mean difference [MD] 4%, 95% CI 3 to 5), higher peak pulse rate (MD 8 bpm, 95% CI 5 to 11), similar intensity of dyspnoea (MD -0.3, 95% CI -0.6 to 0.1) and greater leg fatigue (MD 1.1, 95% CI 0.6 to 1.6). Of those who demonstrated severe desaturation (SpO 2 nadir <85%) on the 6MWT (n = 18), 5 and 10 were classified as moderate (SpO 2 nadir 85% to 89%) or mild desaturators (SpO 2 nadir >= 90%), respectively on the 1minSTS. The equation that represented the relationship between 6MWD and 1minSTS was: 6MWD (m) = 247 + (7 x number of transitions achieved during the 1minSTS;r 2 = 0.44). Conclusion(s): The 6MWT elicited greater desaturation, a lower peak pulse rate and greater leg fatigue than the 1minSTS. A smaller proportion of people will be classified as 'severe desaturators' using the 1minSTS test. The capacity to estimate the 6MWD using results of the 1minSTS is limited.

Pulmonary sarcoidosis

The lung is the most common organ affected by sarcoidosis. Multiple tools are available to assist clinicians in assessing lung disease activity and in excluding alternative causes of respiratory symptoms. Improving outcomes in pulmonary sarcoidosis should focus on preventing disease progression and disability, and preserving quality of life, in addition to timely identification and management of complications like fibrotic pulmonary sarcoidosis. While steroids continue to be first-line therapy, other therapies with fewer long-term side-effects are available and should be considered in certain circumstances. Knowledge of common clinical features of pulmonary sarcoidosis and specific pulmonary sarcoidosis phenotypes is important for identifying patients who are more likely to benefit from treatment.Copyright © ERS 2022.

EXERCISE CAPACITY IS REDUCED IN HIV INDEPENDENT OF SARS-CoV-2 INFECTION

Background: Reduced exercise capacity occurs as a post-acute sequela of COVID-19 ("PASC" or "Long COVID"). Cardiopulmonary exercise testing (CPET) is the gold standard for measuring exercise capacity and identifying reasons for exercise limitations. Only one prior study used CPET to examine exercise limitations among people living with HIV (PLWH). Extending our prior findings in PASC, we hypothesized that PLWH would have a greater reduction in exercise capacity after SARS-CoV-2 co-infection due to chronotropic incompetence (inability to increase heart rate). Method(s): We performed CPET within a COVID recovery cohort that included PLWH (NCT04362150). We evaluated associations of HIV and prior SARS-CoV- 2 infection with or without PASC with: (1) exercise capacity (peak oxygen consumption, VO2) and (2) adjusted heart rate reserve (AHRR, marker of chronotropic incompetence) using linear regression with adjustment for age, sex, and body mass index. Result(s): We included 83 participants (median age 54, 35% female, 10% hospitalized, 37 (45%) PLWH) who underwent CPET at 16 months (IQR 14-17) after SARS-CoV-2 infection. Among PLWH (median duration living with diagnosed HIV 21 years (IQR 15-28), all virally suppressed on antiretroviral therapy), 14 (39%) had not had SARS-CoV-2 infection, 12 (32%) had prior SARSCoV- 2 infection without PASC, and 11 (30%) had PASC (Long COVID symptoms at CPET). Median CD4 count was 608 (370-736) and CD4/CD8 ratio 0.92 (0.56-1.27). Peak VO2 was reduced among PLWH compared to individuals without HIV with an achieved exercise capacity only 80% vs 99% (p=0.005, Fig.), a difference in peak VO2 of 5.5 ml/kg/min (95%CI 2.7-8.2, p< 0.001). Exercise capacity did not vary by SARS-CoV-2 infection among PLWH (p=0.48 for uninfected vs infected;p=0.25 for uninfected vs no PASC;p=0.32 no PASC vs PASC). Chronotropic incompetence was present in 38% of PLWH vs 11% without HIV (p=0.002), and AHRR (normal >80%) was significantly reduced among PLWH vs individuals without HIV (60% vs 83%, p< 0.0001, Fig.). Heart rate response varied by SARSCoV- 2 status among those with HIV: namely, 3/14 (21%) without SARS-CoV-2, 4/12 (25%) with SARS-CoV-2 without PASC, and 7/11 (64%) with PASC (p=0.04 PASC vs no PASC). Among PLWH, CD4 count, CD4/CD8 ratio, and hsCRP were not associated with peak VO2 or AHRR. Conclusion(s): Exercise capacity is reduced among PLWH, with no differences by SARS-CoV-2 infection or PASC. Chronotropic incompetence may be a mechanism of reduced exercise capacity among PLWH. (Figure Presented).

Long COVID-19 syndrome: Association of cardiopulmonary impairment with a persistent platelet activation

Background: A considerable proportion of patients do not fully recover from COVID-19 infection and report symptoms that persist beyond the initial phase of infection: This condition is defined long-COVID-19 syndrome (LCS). LCS can involve lungs as well as several extrapulmonary organs, including the cardiovascular system. The risk and 1-year burden of cardiovascular diseases (CVD) is increased in COVID-19 survivors, even in subjects at low risk of CVD. Recently, we documented that acute COVID- 19 infection induces altered platelet activation state characterized by a prothrombotic phenotype and by the formation of platelet-leukocyte aggregates (PLA), that may be involved in the pulmonary microthrombi found in autoptic specimens. No data are yet available on the contribution of platelet activation to residual pulmonary impairment and procoagulant potential in LCS patients. Purpose(s): To study platelet activation status, microvesicle (MV) profile, platelet thrombin generation capacity (pTGC) in LCS patients enrolled at 6 months after resolution of the acute phase (6mo-FU), compared to acute COVID-19 infection patients. Method(s): 6mo-FU COVID-19 patients (n=24) with established LCS were enrolled at Centro Cardiologico Monzino. Residual pulmonary impairment was assessed by Cardiopulmonary Exercise Testing (CPET) and 64-rows- CT scan evaluation. Platelet activation (P-selectin, Tissue Factor [TF] and PLA) and MV profile were assessed by flow cytometry;pTGC by calibrated automated thrombogram. 46 patients enrolled during acute COVID-19 infection and 46 healthy subjects (HS) were used for comparison. Result(s): Dispnea in LCS patients was confirmed by CPET showing compromised alveolus-capillary membrane diffusion and residual pulmonary impairment. TF+-platelet and -MV levels were 3-fold (1.5% [1.2-2.9] vs 2.4% [1.6-5.7]) and 2-fold (217/mul [137-275] vs 435/mul [275-633]) lower at 6mo-FU compared to acute phase, being comparable to HS. pTGC behaved similarly. At 6mo-FU, the MV profile, in terms of total number and cell origin, returned to physiological levels. Conversely, although lower than that measured in acute phase, a 2.5-fold higher platelet P-selectin expression (6.9% [3-13.5] vs 11.7% [5.2-18.9]) and PLA formation (35.5% [27.4- 46.8] vs 67.7% [45.7-85.3]) was observed at 6mo-FU compared to HS. Interestingly, a significant correlation between PLA formation and residual pulmonary impairment was observed (r=-0.423;p=0.02). Conclusion(s): These data strengthen the hypothesis that the presence of PLA in the bloodstream, and thus also in the pulmonary microcirculation, may contribute to support pulmonary dysfunction still observed in LCS patients.

Evaluation of myocardial work in patients recovered from the severe form of COVID-19

Background/Introduction: The impact of COVID-19 goes beyond its acute form, and can lead to the persistence of symptoms and the emergence of systemic disorders, defined as Post-Covid or Long-Covid. Purpose(s): Assess the late impact on the cardiorespiratory system of patients recovered from severe Covid. Method(s): We performed cross-sectional study that included patients over 18 years of age who recovered from the severe form of COVID-19 after at least 60 days of their discharge. Patients and healthy controls were enrolled to perform transthoracic echocardiography (TTE) and cardiopulmonary exercise testing (CPET). Result(s): A total of 52 patients and 24 controls were enrolled. The standard TTE parameters (end diastolic diameters, left ventricular ejection fraction, diastolic function and right ventricular systolic function) showed no difference when compared to the control group. When analyzing the myocardial work, there was a higher Wasted MW (GWW): 135 mmHg% vs 84.5 mmHg% (p=0.002), with lower MW Efficiency (GWE): 94 vs. 96 (p=0.003);as well as lower values of global strain: Cases = 18.6% vs. 20.1% (p=0.009). No differences were found in the Constructive MW (GWC) and MW Global Index (GWI). In the CPET data we found lower peak values for the VO2: 24 ml/kg/min vs. 32.75 ml/kg/min (p<0.001);for the Heart Rate: 162 bpm vs. 175 bpm (p<0.001);for the Ventilation: 79.3 L/min vs. 109.85 L/min (p<0.001) and Respiratory Exchange Ratio: 1.12 vs. 1.19 (p=0.004). There was no difference in the maximum load reached, neither in the oxygen pulse values and in the Ve/CO2 slope. In relation to the oxygen kinetics, there was a significant reduction in OUES%: 85% vs. 98% (p=0.03);as well as an extended T1/4: 112 s vs. 88.5 s (p<0.001);and a slowing of the fall in heart rate in recovery time, as measured by the Heart Rate decay: -17.32 bpm vs. -22.08 bpm (p=0.005). Conclusion(s): Patients recovered from the severe form of COVID-19 had higherGWWwith lower efficiency (GWE). Such findings, added to changes in oxygen kinetics during exercise, may point to a possible cardiocirculatory mechanism associated with decreased aerobic capacity.

Effects of mask-wearing on treadmill exercise test

Background: Concerning about the spread of COVID-19, World Health Organization recommends wearing facemasks to minimize viral transmission. Patients are required to wear facemasks while conducting treadmill exercise tests in hospitals. The effects of mask-wearing on the results of stress exercise testing remain uncertain. Purpose(s): This study aims to assess the impact of mask-wearing on the physiological parameters during treadmill exercise testing. Method(s): Patients who underwent treadmill exercise test using the Bruce protocol for the diagnosis of ischemic heart disease were retrospectively examined between 2020 and 2021. A propensity score matching was performed to adjust the baseline characteristics of patients with and without mask. Blood pressure, heart rate, exercise duration, and the interpretation of stress test were compared. The ischemic ST-segment response was defined as flat or downsloping depression of the ST seg-ment >0.1 mV below baseline and lasting longer than 0.08 second. Nondiagnostic result of treadmill exercise test was defined as absence of ischemic ST-segment response in which the 90% of maximal predicted heart rate for age and sex was not achieved. Result(s): Following 1:1 propensity score matching, a total of 3,996 patients were enrolled for analysis, including 1,998 patients who performed treadmill exercise testing with masks, and 1,998 without masks. Baseline characteristics were similar between the two groups (mean age, 56.1+/-12.1 years;38.7% female;mean body mass index, 25.5+/-3.9 kg/m2). At baseline, patients with masks had significantly higher heart rate (84.8+/-14.7 bpm vs. 82.5+/-14.0 bpm;p<0.001) and lower systolic blood pressure (130.4+/-19.0 mmHg vs. 132.4+/-18.7 mmHg;p=0.001) than those without masks. Patients with masks conducted significantly shorter duration of exercise (435+/-128 seconds vs. 481+/-133 seconds;p<0.001), achieved significantly lower measurement of peak heart rate (149.5+/-17.1 bpm vs. 152.7+/-17.0 bpm;p<0.001), and had significantly lower rate-pressure products (26,366+/-5,207 mmHg bpm vs. 27,629+/-5,242 mmHg*bpm;p<0.001) than those without masks. The proportion of patients who were unable to complete stage II of the Bruce protocol was significantly higher among patients with masks (15.1% vs. 9.0%;p<0.001). The proportion of nondiagnostic result was significantly higher among patients with mask (12.2% vs. 8.8%;p<0.001), whereas the proportion of positive ischemic STsegment response rate was significantly higher among patients without mask (28.1% vs. 23.3%;p=0.001). Conclusion(s): Our study demonstrated that performing treadmill exercise test with mask could significantly decrease the duration of exercise, reduce the maximal achieved heart rate, decease the rate-pressure product, and thus reduce the diagnostic power of treadmill exercise testing.

Effect of real-time remote-based cardiac rehabilitation on subjective satisfaction and objective performance during the coronavirus disease 2019 pandemic

Background: Real-time remote-based cardiac rehabilitation (CR) programmes improve exercise capacity. However, satisfaction and performance improvements after remote-based CR remain unclear. In addition to physical function, subjective satisfaction and objective performance may be adversely affected during the coronavirus disease 2019 pandemic. Purpose(s): This study aimed to compare the effectiveness of real-time remote-based CR versus hospital-based CR in improving physical function, subjective satisfaction, and objective performance (i.e., activity limitations and participation restrictions). Method(s): We conducted a quasi-randomised controlled trial and recruited 38 patients with cardiovascular disease (CVD). The patients participated in 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospitalbased CR based on quasi-randomised allocation. We assessed the participants at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for objective performance, and peak oxygen uptake (peak VO2) using the cardiopulmonary exercise test, for physical function. We evaluated individual results by measuring baseline to post-CR changes (i.e., delta [DELTA]) (paired t-test) and then compared the remote and hospital-based CR programmes (unpaired t-test). Result(s): Sixteen patients (72.2+/-10.4 years) completed remote-based CR and fifteen patients (77.3+/-4.8 years) completed hospital-based CR. Seven patients were excluded owing to other health complications (n=2) and inability to attend hospital based-CR (n=5). In the remote-based CR group, the peak VO2 (before: 12.0+/-2.7 mL min-1 kg-1;after: 14.9+/-3.9 mL min-1 kg-1;p<0.05) and the WHOQOL-BREF score (before: 77.4+/-12.8 points;after: 93.9+/-12.9 points;p<0.001) were significantly higher, whereas the WHODAS 2.0 score was significantly lower (before: 19.9+/-13.2 points;after: 11.3+/-6.8 points;p<0.05) after rehabilitation than at baseline. The post- CR physical function differed significantly between the two groups (DELTApeak VO2, remote: 2.8+/-3.0 mL min-1 kg-1;hospital: 0.84+/-1.8 mL min-1 kg-1;p<0.05). The post-CR change in the WHOQOL-BREF score was not significantly different between the groups. The post-CR change in the WHODAS 2.0 score was significantly lower in the remote-based CR group than in the hospital-based CR group. (DELTAWHODAS 2.0 score, remote: -8.56+/-14.2 points;hospital: 2.14+/-7.6 points;p<0.01). Conclusion(s): Remote-based CR significantly improved physical function and objective performance in patients with CVD. Remote-based CR could be an effective treatment for stable patients who are unable to visit the hospital during the coronavirus disease 2019 pandemic. In the future, risk stratification according to severity of illness is needed.

Cardiopulmonary exercise testing and ventilatory efficiency in long COVID-19: 15 months follow-up

Long COVID-19 is defined as persistency of symptoms, such as exertional dyspnea, twelve weeks after recovery from SARS-CoV-2 infection;its pathophysiology still needs to be fully understood. We investigated exercise tolerance and ventilatory efficiency using cardiopulmonary exercise testing (CPET) in patients with long COVID-19. Methods. One hundred patients admitted to our hospital from March to August 2020 for a moderate to critical COVID-19 were enrolled in our long COVID-19 program. Medical history, physical examination and chest HRCT were obtained at hospitalization (T0), at 3 (T3) and 15 months (T15). All HRCTs were revised using a semiquantitative CT severity score (Pan, F. et al. Radiology 2020;295(3):715-721). Pulmonary function tests (PFTs) were obtained at T and T . CPET was performed at T15 in twenty patients (10 male/10 female;mean age 62 years) with residual respiratory symptoms (e.g., exertional dyspnea) and/or an impairment in PFTs, DLCO and/or KCO . Results. At CPET, peak oxygen uptake (VO2 -peak) and ventilatory efficiency (VE /VCO2 slope) were 95.9+/-18.4 SD %pred and 31.4+/-3.9 SD, respectively. Of notice, significant correlations between VE/V'CO2 slope and CT score (T0 ) (r=0.403;p=0.039), CT score (T3) (r=0.453;p=0.022) and DLCO (T3 ) (r=-0.465;p=0.019) were observed. Conclusions. At fifteen-months from COVID-19 pneumonia, a significant number of subjects (20%) still complains of exertional dyspnea. At CPET this may be explained by reduced ventilatory efficiency (i.e., increase in VE/VCO2), possibly related to the degree of lung parenchymal involvement in the COVID-19 acute phase, likely reflecting a damage in the interstitial/pulmonary capillary structure.

Effects of face masks on cardiopulmonary performance in a partly double-blinded randomized cross-over study

Background: The use of face masks in the public and at work became mandatory as a result of the SARS-CoV-2 pandemic in many countries. Wearing masks under physical work or for a prolonged time may lead to complaints of labored breathing and increased stress. The influence of three types of masks on cardiopulmonary performance was investigated in a randomized cross-over design. Method(s): Forty volunteers (20 women, 19-65 years) underwent bodyplethysmography, spiroergometric and ergometric exercise tests without mask, with a surgical mask, a community mask and a FFP2 mask. Additionally, a 4hour mask wearing period was investigated during regular work (office or laboratory). Cardiopulmonary, physical, capnometric, and blood gas-related parameters were recorded. Result(s): Breathing resistance and work of breathing were increased when wearing a mask. During physical exercise minute ventilation was lower and the breathing cycle time was extended with mask. Wearing a mask caused minimal decreases in blood oxygen partial pressure (pO2) and oxygen saturation (sO2) and an initial slight rise in blood carbon dioxide partial pressure (pCO2) during exercise. All effects were most pronounced with FFP2. Temperature, humidity, and inspiratory CO2 concentration slightly increased behind the mask. No changes in pO2, sO2, and pCO2 were observed during the 4-hour wearing period at work. Conclusion(s): Wearing face masks at rest and under workload changed the breathing pattern in the sense of physiological compensation. Wearing a mask for 4 hours during light work had no effect on blood gases and no adverse effects were observed throughout all testing.

Impact of SARS CoV2 infection on pulmonary gas exchange and exercise capacity in patients with mild to severe COVID-19

Since beginning of 2020, SARS-CoV2 pandemic has been prevailing in humans causing COVID-19. Airways are strongly impacted during virus mediated inflammation and damage. Exact pathomechanisms during COVID-19 are still under investigation. We now further characterized limitations in exercise capacity in outpatient patients after symptomatic infection with SARS-CoV2 using bicycle cardiopulmonary exercise testing (CPET). 45 patients (21female/24 male) underwent standard pulmonary function testing (PFT) including spirometry, bodyplethysmography, CO-diffusion-measurement (DLCO, DLCO/VA), capillary blood gas-analysis (BGA) and symptom limited CPET on a bicycle. Patients' disease history was evaluated in advance. Severity of the disease was quantified according to reported data. At rest, there were no statistically relevant abnormalities in spirometry, bodyplethysmography, CO-diffusion-measurement or blood gas-analysis, even in those patients less than 40 days post infection. We found significantly impaired alveolar-arterial oxygen gradients (A-aO2) and decreased peak V'O2 level post-COVID-19 patients up to up to 80days post infection. Reevaluating 10 patients 3 month later, a markedly increase in peak oxygen-uptake (V'O2) and a normalized A-aO2 at rest was noted. We conclude that COVID-19 resulted in decreased cardiopulmonary exercised capacity as demonstrated by CPET (significantly decreased peak V'O2). The underlying mechanism is limitation of oxygen-diffusion indicated by significantly elevated A-aO2 level in post-COVID-19 patients. Limitation was temporary and patients reached age-appropriate level 3 month later.

Post-COVID-19 Exercise Stress Test

Objectives: Atypical chest pain, fatigue, and palpitations can be seen in post-coronavirus disease-2019 (COVID-19) period. With the hypothesis of explaining these complaints, we evaluated the exercise stress test (EST) parameters in COVID-19 patients with mild disease. Material(s) and Method(s): Between the ages of 30-50 years, who had mild COVID-19 in the last 3-9 months, were taken as the COVID-19 group [n=80, male/female (M/F): 40/40]. A total of 160 patients were included, of which age and gender matched 80 patients (M/F: 40/40) without COVID-19 were the control group. During the EST, baseline heart rate HR1(beats/min), baseline systolic, diastolic blood pressure (mmHg) (SBP1, DBP1), maximum blood pressures (SBPmax, DBPmax), and blood pressure changes (DELTASBP, DELTADBP) were recorded. As EST parameters, Duke score, exercise time (min), ST change (mm), exercise capacity (METs), maximum reached HR (% beats/min), distance walked (m), maximum oxygen consumption amount (VO2max mL/kg/min), rate pressure product (RPP mmHg/min/1000), and heart HR recovery 1 (HRR1 beats/min) was used. Result(s): In the COVID-19 group, baseline HR1, SBP1, DBP1, SBPmax, DBPmax, DELTASBP, DELTADBP, VO2max, and RPP were higher, while distance walked and HRR1 were less. There was no difference between the two groups in terms of Duke score, exercise duration, ST change and exercise capacity. Conclusion(s): The fact that the exercise capacities in the COVID-19 group were similar to those in the control group, but there was a difference in the changes in heart rate and blood pressure, RPP, HRR1 suggested that the autonomic system might be affected.Copyright © 2022 by Heart and Health Foundation of Turkey.

Validation of the one minute sit to stand test(1MSTS)for identification of exertional oxygen desaturation in chronic respiratory disease

Background: Despite limited validation data (Kalin et al Systematic Reviews 2021 Mar 16;10(1):77), the 1MSTS was widely used as a rapid exercise test to assess exertional oxygen desaturation during the COVID-19 pandemic. Aim(s): To assess the diagnostic accuracy of the 1MSTS to detect significant exertional oxygen desaturation in people with chronic respiratory disease. Method(s): 99 patients referred for pulmonary rehabilitation assessment were assessed for ambulatory oxygen requirements using a shuttle walk test according to British Thoracic Society Guidelines for Home Oxygen Use. Exertional oxygen desaturation was defined as a drop in oxygen saturations (SpO ) of >=4% with nadir <90%. 1MSTS was conducted in each participant by an assessor blinded to ambulatory oxygen assessment results. Result(s): Mean(SD) age 68.9(11.4) years, 59%COPD, 13%ILD. 21% demonstrated significant exertional oxygen desaturation. Using a drop of SpO >=4% to nadir <90% threshold, the 1MSTS only identified 6 out of 21 patients with exertional oxygen desaturation (sensitivity 29%). Simplifying the threshold to a drop in SpO of >=4% alone during 1MSTS improved sensitivity to 81% with specificity of 87%. Conclusion(s): Using a threshold of drop in SpO of >=4%, the 1MSTS test had reasonable sensitivity and specificity identifying significant exertional oxygen desaturation in patients with chronic respiratory disease.

Cardiopulmonary exercise testing in patients with COVID19 at 3 months from hospital discharge

Introduction: The long-term COVID-19 effects are currently unknown. Whether and for how long symptoms extend beyond the acute phase of the disease is unresolved Aim: To determine the functional capacity of COVID-19 survivors by cardio- pulmonary exercise testing (CPET) and describe its association with dyspnoea and pulmonary function test (PFT). Methods and Results: All COVID-19 patients discharged from our tertiary care institution were enrolled in a prospective follow-up study which would assess clinical, instrumental and laboratory characteristics of COVID-19 survivors at 3months from hospital discharge (Careggi University Hospital, Florence). Clinical evaluation included: peripheral blood samples including inflammatory cytokines, pulmonary function test (functional respiratory and 6 minwalking test), lung ultrasound, ECG recording and echocardiographic exam. All patients with peripheral oxygen desaturation at 6 min-walking test (SpO2 < 92%), dyspnoea and with a history of hospitalization in critical care settings were referred for CPET. Dyspnoea was classified with the Medical Research Council (MRC) scale. From June 2020 to May 2021, 198 patients were enrolled;overall, 42% of patients presented with dyspnoea at 3 months from hospital discharge with no difference according to disease severity on hospital admission (P 1/4 0.233) Conclusion(s): At 3-months, almost 1 in 2 patients discharged for COVID-19 pneumonia presented with dyspnoea, irrespective of disease severity. We want to compare CPET and spirometry data (already performed in 110 patients), highlighting differences between ventilated patients (invasive or noninvasive) and patients admitted to the ward. The data are still being analyzed.

To Evaluate the Correlation between Dasi Mets and the Incremental Shuttle Walk Test (Iswt) in Patients with Cardiovascular Disease (Cvd)

Background The Duke Activity Status Index (DASI) questionnaire assesses functional capacity of patients with cardiovascular disease (CVD[1]figure 1.). DASI derives a total score and corresponding METs level. We utilised this questionnaire during COVID-19 when face to face (F2F) functional capacity testing was an unavailable outcome measure for cardiac rehabilitation (CR). Aim To evaluate the correlation between DASI METs and the incremental shuttle walk test (ISWT)and establish if it is a reliable tool to estimate functional capacity in patients with cardiovascular disease (CVD). Methods DASI questionnaire was completed over the phone as part of a subjective assessment. Two ISWTs were performed at a F2F appointment prior to starting class, best of two, taken. Measures were repeated post-CR completion. Results 93 patients, 64.5% male, mean age (SD) 65.3 (9.6) years, assessed at baseline. Patients' presentation: 27% NSTEMI, 24% STEMI, 16% Angina, 13% Heart failure and 20% other. Outcomes pre to post CR are shown in table 1. Correlation between DASI METs and the ISWT at baseline was r= 0.32 [weak positive (p<0.05)] and post-CR was r= 0.67[strong positive (p<0.01)]. The ISWT change was similar to the minimum important difference (MID) 70m in the CHD population. There is no MID for the DASI Conclusions Patients attending CR post-pandemic made significant improvements in both the DASI and ISWT. Correlations became stronger post programme, indicating patients may better self-evaluate physical performance after taking part in CR. DASI questionnaire may be a useful alternative outcome measure when F2F exercise testing is not an option. Future work could explore how to prescribe an exercise programme from this and what might represent a meaningful change in this outcome following CR (Table Presented).

Effectiveness of a long-term home-based exercise training in COPD patients: The HOMEX-2 RCT

Introduction: Many COPD patients do not follow pulmonary rehabilitation (PR) or exercise training in the long-term. Objective(s): To assess the effectiveness of a 12-months home-based, minimal equipment strength exercise programme in patients with COPD who did not conduct PR<1 year. Method(s): COPD patients recruited from primary care and general population were randomized into intervention (IG) or control group (usual care, CG). Primary outcome was change in dyspnoea (Chronic Respiratory Questionnaire;CRQ) from baseline to 12 months, secondary outcomes change in exercise capacity, health status, exacerbations, and symptoms. Adjusted linear regression models were used. Result(s): 50 patients (48% of target sample size) were randomized (25 per group);23 females, mean (SD) age 69.5 (7.4) years, FEV1% 45.9 (16.3) % pred. 48 completed 12-months follow-up (IG: 25, CG: 23). On average, the IG participant trained for 10.5 months and 18 persons (72%) until study end. We found no evidence for a difference in change in CRQ dyspnoea over 12 months (adjusted mean difference 0.45, 95% CI -0.21-1.10, p=0.18, favouring IG). We found no evidence for an effect in other outcomes. Most of the IG participants liked to participate in the programme much (56%) or very much (24%). Due to the Coronavirus pandemic, 60% of follow-up visits were conducted by phone/by questionnaires without exercise tests. Conclusion(s): This trial was underpowered. There was a trend that the training provided benefit in dyspnoea. The fact that it was difficult to motivate COPD patients for participation who did not follow PR<1 year highlights the challenge to reach this patient group. However, most of the participants succeeded to train long-term.

Submaximal and maximal exercise tests in the follow up of severe Covid-19

Background: One-minute sit and stand test (1STST) is a very feasible test of functional capacity. The maximal cardiopulmonary exercise test (CPET) is more complex and comprehensive to evaluate exercise capacity. These tests might have different responses in the late recovery of patients with Covid-19. Aim(s): Identify the persistence of capacity limitation through 1STST and CPET at 30 and 90 days after the onset of symptoms in patients who had a severe and critical illness from Covid-19. Our hypothesis is that 1STST is a submaximal test limited by time and may not detect exercise capacity limitation in some patients. Method(s): Prospective study involving 17 patients with severe Covid-19. The time of the first 5 repetitions and the number of repetitions in 60 seconds in 1STST were used to identify lower performance. Maximal CPET on the cycle was performed and peak VO <= 83% pred was used to confirm lower performance. Result(s): The 1STST was considered submaximal and identified 52% of the patients with greater time than expected to perform 5 repetitions in 30 days, and only 11.8% in 90 days. The number of repetitions in 60 sec was reduced by 58.8% at 30 days and persists this reduction by 11.8% at 90 days (table). CPET identified a much lower performance of 58.8% mainly after 90 days. Conclusion(s): Both tests had different responses in the magnitude of recovery from 30 to 90 days after severe Covid-19. There is a substantial proportion of patients who are potentially impaired and improved in 1STST but not in CPET.