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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).
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Background: Peak oxygen uptake (VO 2) is often the focal point of cardiopulmonary exercise testing among patients with heart failure (HF). Breath-by-breath VO 2 kinetic patterns at exercise onset, during low-level and submaximal exercise, and during recovery may provide incremental insight into HF severity and etiologies of exercise limitation. Objective: The aim of this systematic review was to explore VO 2 recovery delay (VO 2 RD) across the spectrum of left ventricular function. Methods: A systematic review was conducted using several online databases (EMBASE, Cumulative Index to Nursing and Allied Health Literature, PubMed and Web of Science). Steps outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed. Search terms included VO 2 RD OR VO 2 off kinetics AND HF, peak VO 2 AND recovery. All articles were uploaded to Covidence. Results: Four studies met the inclusion criteria. The definition of VO 2 RD varied across studies. Recovery delay was consistently observed in HF patients compared to controls indicating VO 2 RD discriminates between those with and without HF. Control groups showed VO 2 decline almost immediately after exercise. VO 2 RD had a significant positive linear relationship to N-terminal prohormone of brain natriuretic and Doppler echo E/e' while demonstrating an inverse relationship with peak cardiac output and survival duration. Conclusions: VO 2 RD, unlike peak VO 2, is relatively cardiospecific. Oxygen recovery kinetics offer insight into disease severity and discrimination of healthy participants from those with HF. © 2023 Heart and Mind ;Published by Wolters Kluwer - Medknow.
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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.
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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.
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Background Cardiac rehabilitation (CR) is a Class 1 indication for patients following acute coronary syndrome, coronary intervention and in patients with chronic, stable heart failure. However, rates of participation remain abysmal. Following the COVID-19 pandemic, interest in remote cardiac rehabilitation (R-CR) has increased. Efficacy of R-CR versus the current standard of care remains unclear. Methods A systematic review of the available literature was performed according to the PRISMA 2020 checklist. Of the identified studies, further screening was done to isolate randomized controlled trials (RCT) that measured objective markers of physical fitness such as peak oxygen consumption during exercise (VO2 max) and distance traveled during 6 minute walk test (6MWT). Results 20 RCTs were identified that compared R-CR versus either standard CR or usual care that did not include a component of CR. There is no difference in the change in exercise capacity achieved based on whether a patient underwent R-CR versus standard CR. There was a significant difference in the change in exercise capacity achieved in patients who underwent R-CR versus usual care. R-CR is associated with a significant change in VO2 max but not distance walked on 6MWT. Conclusion R-CR is not inferior to standard CR in improving VO2 max and distance walked on 6MWT. R-CR may be superior to usual care that does not include an element of CR. This is potentially beneficial as increased adoption of R-CR may improve participation in CR as a whole. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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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.
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Background: After mild Covid-19, a subgroup of patients reports post-acute sequelae of Covid-19 (PASC), in which exertional dyspnea and perceived exercise intolerance are common. Underlying pathophysiological mechanisms remain incompletely understood. We studied outcomes from cardiopulmonary exercise test (CPET) in these patients. Method(s): In this observational study, we included patients referred for the analysis of PASC after mild Covid-19 in whom CPET was performed after standard clinical work-up turned out unremarkable. Cardiocirculatory, ventilatory and metabolic response to, and breathing patterns during exercise at physiological limits were analyzed. Result(s): Twenty-one patients (76% female, mean age 40y) who reported severe fatigue (CIS-fatigue >= 35), dyspnea (mMRC 2 (IQR1-2)) and disability in physical role functioning (SF-36) underwent CPET at 32 weeks (IQR 22-52) after Covid-19. Mean peak oxygen uptake was 99% (SD13) of predicted with normal anaerobic thresholds at 62% (SD11) of predicted oxygen uptake. No cardiovascular or gas exchange abnormalities were detected. Twenty out of the 21 patients (95%) demonstrated breathing dysregulation, existing of ventilatory inefficiency (29%), abnormal course of breathing frequency and tidal volume (57%), and acute or chronic respiratory alkalosis in resting blood gases (67%). Conclusion(s): In the absence of deconditioning, breathing dysregulation may explain the experienced exertional dyspnea and exercise intolerance in patients with PASC after mild Covid-19.
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Background: Pulmonary Rehabilitation (PR) is recommended for patients that suffered from severe COVID19. The exercise and training response as well as predictors of response are not yet well studied. Aim(s): To study the response to an incremental exercise test performed before and after 12 weeks of outpatient PR. Method(s): An exercise test was conducted in 37 of 70 patients that completed PR after COVID19, (age 52+/-9, BMI 29+/-6, 20 male, FEV1 89+/-21%pre, 31 hospitalized). Result(s): Before starting PR, exercise tolerance was reduced. A cardiac, ventilatory, gas exchange and muscular limitation was observed in 24%, 22%, 37% and 45% of patients respectively. Physiologic limitations were inconclusive in 19% of patients. After completing PR, significant desaturation was still seen in 30% of patients. Rehabilitation increased Wmax by 58+/-55% and VO2max by 40+/-38% of baseline values with significant improvements in O2pulse (see table1). Multiple regression revealed that improvement in VO2peak was associated with gender (+386ml/min in male p=0.01 Partial R2=0.14), and Hospital anxiety and depression scale -21ml/min per baseline point in total score (partial R2 0.18 p=0.03). Quadriceps force did not significantly enter the model (p=0.1). Conclusion(s): Peak exercise tolerance increased rapidly upon initiation of PR in patients after COVID19. In patients with psychologic morbidity at baseline, this response seems somewhat blunted.
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Persistent fatigue is a common, debilitating, and poorly understood symptom post-COVID-19. Fatigue post-COVID19 is not associated with disease severity, and therefore not limited to those recovered from severe infection. Using cardiopulmonary exercise testing (CPET), we sought to characterize differences between those with vs. without postCOVID-19 fatigue. 49 individuals were included 3-months post-discharge if hospitalized with COVID-19 or 3-months after their last positive SARS-CoV-2 test. Participants were grouped based on the presence of any persistent fatigue relative to the acute phase of infection (fatigue, n=34) or lack thereof (non-fatigue, n=15). An incremental CPET on a cycle ergometer was performed to symptom limitation. Participants also completed self-administered questionnaires, pulmonary function testing, and a resting echocardiogram. While dyspnoea intensity ratings were elevated in the fatigue group throughout exercise (p=0.04), relative peak oxygen consumption was the only significant betweengroup difference in physiological responses (19.9+/-7.1 fatigue vs. 24.4+/-6.7 ml/kg/min non-fatigue, p=0.04). Anxiety, depression, and distress were higher in those with fatigue vs. without, despite similar resting pulmonary and cardiac function as well as COVID-19 disease severity. Our findings suggest that cardiorespiratory fitness and/or psychological factors may contribute to post-COVID-19 fatigue. It is also possible that a higher psychological burden intensifies symptom perception such as dyspnoea during exercise in those with vs. without fatigue or that fatigue leads to secondary psychological symptoms.
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Background and Aim: Wearing face masks to detain the COVID 19 pandemic in schools has become an integral part of fighting the virus. The most effective mask is the FFP2 mask. There is a lot of public concern, especially regarding wearing a face mask at school and especially during school sports. It is therefore important to determine whether wearing a FFP2-mask during physical activ-ity leads to changes measurable in cardiopulmonary exercise test-ing in children. Method(s): Cardiopulmonary exercise testing was performed two times by children aged 8-10 years as an incremental step test on a treadmill with and without a FFP2 within an interval of 2 weeks. A general questionnaire included medical history and sports par-ticipation since childhood. Result(s): We included 10 children (mean age 8.4 +/- 0.7 years, 6 males, 4 females). The mean parameters measured at peak exercise were comparable between both examinations (mean Peak VO2 = 39.3 +/- 3.4 vs 45.6 +/- 13.9 ml/min/kg;mean Peak HR 192/min +/- 9 vs 188/min +/- 12, mean O2pulse 6 +/- 1.4 ml/min vs. 7 +/- 1.8, mean VE 43.2 +/- 12.9 ml/min vs. 41.5 +/- 12.7 ml/min). Neither did the respiratory gases (O2 and CO2) measured 1 min into each step differ significantly (s. figure). This study is cur-rently ongoing. Conclusion(s): Since there were no significant differences with respect to peak parameters as well as with respect to the respiratory param-eters measured during each step, there is no indication to withhold physical activity even at peak capacity from children during a pan-demic which makes wearing face masks mandatory.
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Background and Aim: The COVID-19 lockdown in Germany has led to the closure of sports facilities and to the closure of schools with their curricular physical activities (PA). However, physical activity is essential for improving or at least maintaining cardiopulmonary function assessed by VO2peak. VO2peak represents the best pre-dictor for mortality and morbidity in patients with congenital heart disease (CHD). It is therefore essential to evaluate the effect of lock-downs on this important parameter in children with heart disease. Method(s): We evaluated data from cardiopulmonary exercise data from before lockdown with twin-paired data from during lockdown. The statistically approved twin-pairing was achieved by matching patients with similar heart disease, age, sex, and test method. The subjects con-sisted of a variety of patients who had received cardiopulmonary exer-cise testing in our department in the past 3 years. Result(s): We were able to twin-pair 52 tests leading to 27 twins. A mean RER of more than 1.1 was achieved in both groups with comparable exercise times. There was a significant decrease of cardiopulmonary function (VO2peak: 35.7 +/- 9.8 vs.30.4 +/- 10.6) in our patient cohort along with a significant decrease in peak O2pulse (13.3 +/- 4.1 vs. 11.4 +/- 4.5), a surrogate parameter for stroke volume and most pronounced in peak minute ventilation (VE: 83.05 +/- 29.08 vs.71,49 +/- 24.96). Conclusion(s): We observed a significant decline of V O-2peak during lockdown. This involved a loss of cardiac function assessed by O2pulse as well as a loss of pulmonary function assessed by V E. We believe that the decline of these important predictive param-eters could be explained by the limited access to sports facilities as well as the restriction of regular daily movement as a consequence of closing schools and thus curricular PA. Measures need to be established to ensure access to physical activity for children suffer-ing from heart disease during lockdowns.
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Background and Aim: Since December 2019 the novel coronavirus disease 2019 (COVID-19) has been burdening all health systems worldwide. However, cardiopulmonary repercussions in paediat-ric patients with congenital heart disease (CHD) are unknown. The aim of this study is to compare changes in cardiopulmonary exercise test (CPET) in this patients before and after COVID-19. Method(s): Prospective observational study was lead comparing CPET results after COVID-19 in paediatric patients with stable CHD who had a previous routine CPET. All underwent for stand-ardised CPET, using Godfrey ramp protocol as recommended by the European Society of Cardiology (ESC). Measured variables, expressed by predicted values, were: forced vital capacity (FVC), forced expiratory volume (FEV1), ratio of minute venti-lation to carbon dioxide production (VE/VO2 slope), peak oxy-gen consumption (peak VO2), oxygen uptake efficiency slope (OUES), oxygen pulse (O2 pulse) and peak heart rate (pHR). Wilcoxon test was used to compare continuous variables for related samples. Result(s): Ten patients (6 boys, 60%;mean age 11,4 +/- 2,4 years) with hemodynamically stable CHD (3 Tetralogy of Fallot, 30%;2 trans-position of the great arteries, 20%;2 dilated cardiomyopathy, 20%;2 Kawasaki disease, 20%;1 cardiac tumor, 10%) were selected to repeat a post-COVID CPET. All of them had mild COVID and could follow ambulatory treatment. Comparing before/post COVID tests, there were no significantly changes in predicted res-piratory parameters: FVC (90,6 +/- 7,4 vs 98,1 +/- 23,9%;p = 0,799), FEV1 (89,5 +/- 13,8 vs 94,5 +/- 8,8%;p = 0,475), VE/CO2 slope (31,6 +/- 3,7 vs 30,6 +/- 3,9degree, p = 0,203). In the same way, no significantly changes were seen in cardiovascular predicted parameters: oxygen pulse (97,3 +/- 19,2 vs 98,5 +/- 17,4%, p = 0,798), peak VO2 (82,4 +/- 19,4 vs 76,8 +/- 13,7;p = 0,123) and OUES (1,79 +/- 0,4 vs 2,01 +/- 0,6;p = 0,066). Respect peak VO2, there was a non-significant slightly decrease in post-COVID test (82,4 +/- 19,4 vs 76,8 +/- 13,7;p = 0,123). Conclusion(s): In our series, post-COVID CPET results showed that paediatric patients with hemodynamically stable CHD had no impairment in their functional capacity in relation to Sars-CoV-2 disease. Contrary to adults with previous cardiovascular disease, children should have mild infections without sequelae in cardio-pulmonary function.
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Objectives: Elexacaftor/tezacaftor/ivacaftor (ETI) combination therapy - Kaftrio® was approved for use in the UK in August 2020 for those aged >12 years. Our study aimed to study the effects of ETI therapy on lung function and exercise performance. Methods: Two-centre retrospective analysis of clinical data obtained during patients’ annual review assessments. Patients had undergone spirometry and static lung volume measurements followed by an incremental maximal ramp cardiopulmonary exercise testing (CPET) performed on a cycle ergometer. Data were analysed using a paired sample t-test. Results: Lung function improvement did not reach statistical significance. Of note, four patients had a baseline (pre-ETI) FEV1 belowthe lower limit of normal (LLN <-1.64 Z scores), and one improved their FEV1 from 41% predicted to 87% with Kaftrio®. Five had a VO2peak% predicted below the LLN (< 85% predicted) prior to treatment and 8 post treatment. Therewas a significant fall in VO2peak % predicted, p = 0.03. However, this was not seen in the VO2peak relative to bodyweight, p = 0.07. There was also a significant fall in VO2 at anaerobic threshold (AT) as a % of predicted VO2peak, p = 0.01. Table 1. (Table Presented) (Table Presented) Conclusions: This real-world study suggests Kaftrio® does not improve exercise capacity in the majority of CF patients. It is hypothesised that the lack of improvement may be due to a reduced physical activity over the study period as a result of feeling better on Kaftrio® and also the SARSCoV2 pandemic. The decrease in VO2 at AT would support the hypothesis of physical deconditioning. The reasons for not seeing statistical differences in lung function are likely to represent the relatively high baseline FEV1 alongside small study numbers. In summary, whilst having the potential to be a performance-enhancing drug, performance gains on Kaftrio® can only occur if matched by training, and studies to investigate the training potential of Kaftrio® are required.
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Background: Cardiorespiratory fitness (CRF) is a powerful predictor of all-cause mortality among individuals with coronary artery disease (CAD). A structured community-based phase III cardiac rehabilitation (CR) is very important in lifelong maintenance of phase II CRF and health gains. During the COVID-19 pandemic, CR programs had to adapt, mainly using new technologies and remote follow-up. The CRF impact in patients (Ps) who kept going their phase III program, during this troubled era is still unknown. Purpose: Assess the variation in CRF and prognostic parameters in Ps with CAD who maintain high adherence levels in their phase III CR before and during the COVID-19 pandemic. Methods: A cohort of Ps enrolled in a community-based phase 3 CR program, with active participation at the end of 2019, was included in this retrospective study. The inclusion criteria for this study were high levels of attendance (>80%) to the CR program before and during COVID-19 and high levels of physical activity with more than 150 mins of moderate to vigorous physical activity (MVPA). All Ps were evaluated with transthoracic echocardiography (TTE) and a cardiorespiratory exercise test (CPET) in a cycloergometer in 2019 and between october and november of 2021. All Ps had used accelerometers to measure their physical activity levels and dual-energy absorptiometry (DEXA) scan to evaluate their body composition. Between 2020 and 2021, Ps had online (in lockdown periods) and face to face exercise training sessions, 3xtimes per week, 60 mins each exercise session. A t-test paired two sample for means was used to compare CPET variables before the beginning of the first COVID lockdown (end of 2019) and after the removal of the majority of restrictions (end of 2021). Results: A total of 30 Ps with high levels of adherence were included (99.6% male, 65 ± 9 years old). In this cohort, the majority had history of an ACS before the referral to the CR program (73.3%) and 55.6 ± 10.4% of left ventricular ejection fraction. There was no significant difference in body mass index (27.9 ± 3.2 kg/m2 vs 28.1 ± 3.6 kg/m2, p=0.493 but there was a significant increase in the percentage of body fat mass (30.1 ± 5.7% vs 31.0 ± 6.6%, p= 0.042). There was a maintenance on MVPA levels (352 ± 137 minutes/week vs 313 ± 194 minutes/week, p = 0.106) during this period. When comparing the 2 CPET results, Ps achieved higher exercise loads in the 2021 test (175 ± 51W vs 185 ± 52W, p=0.005), higher VO2 peak (25.3 ± 6.9 ml/kg/min vs 21.5 ± 6.3 ml/kg/min, p =0.001) and higher percentage of predicted VO2max (78.8 ± 16.8% vs 95.27 ± 20.8%, p = 0.001). Conclusion: In spite of all the difficulties in maintaining a phase III CR program during the COVID-19 pandemic, we observed that in physically active CAD Ps, with the aid of new technologies and remote follow-up (during the lockdown periods) and face to face exercise sessions, it is still possible to have functional gains and improvements in CRF. (Figure Presented).
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Background: Post-COVID-19 persistent symptoms and exercise intolerance are poorly understood. Cardiopulmonary exercise testing (CPET) assessment is important to address the sources of the underlying symptoms and limitations. Purpose: To evaluate the source and magnitude of exercise intolerance in post-COVID-19 subjects via CPET. Methods: This cohort study assessed subjects with different SARS-CoV-2 illness severities. The propensity score matching method was used to select the control group. Patients with available CPET prior to SARS-CoV-2 infection were compared before and after COVID-19. Results: 288 subjects (144 post-COVID-19 and 144 matched-controls) were assessed. The median age was 43.0 years, and 57% were male, with different illness severity (60.4% mild, 20.8% moderate, 18.8% severe). Residual symptoms were reported in 41% of the sample. CPET was performed 14.4±9.4 weeks after disease onset, with exercise limitations being attributed to the peripheral muscle (91.7%), pulmonary (6.3%), and cardiovascular (2.1%) systems. Lower median percent-predicted peak oxygen consumption was observed in the severe subgroup (72.2%) compared to both mild (98.5%) and control subgroups (91.6%). Peak oxygen consumption (peakVO2), VO2 at the ventilatory thresholds (VO2 at VT), and heart rate differed among illnesses, severities, and controls. Conversely, ventilatory equivalents, oxygen uptake efficiency slope, and peak oxygen pulse were similar (Figure 1). Additional subgroup analysis of 42 subjects with prior CPET revealed changes only on peak treadmill speed in the mild subgroup and additional reductions on peakVO2 and VO2 at VT in the moderate/severe subgroup (Figure 2), while ventilatory equivalents, oxygen uptake efficiency slope, and peak oxygen pulse remained unchanged. Conclusions: Peripheral muscle fatigue was the most common etiology of exercise limitation in post-COVID-19 patients regardless of the SARS-CoV-2 illness severity. Our data suggest that treatment should emphasize comprehensive rehabilitation programs, including aerobic and muscle strengthening components. (Figure Presented).
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Introduction: An increase it is being seen in patients who are referred for consultation due to dyspnea persistent after having overcome COVID19. The cause for this sequel is still not entirely clear, but our group has observed -in another study- that the consumption of oxygen (VO2) determined by cardiopulmonar exercise test (CPET) in these patients is low with respect to its predicted (p50). The objective of the present work was to demonstrate this hypothesis against to a control group with similar characteristics, who have not suffered from COVID19. Methods: We conducted a prospective study with military personnel who are part of a corps of army elite. All subjects have performed the same training daily during the last 2 years. They were divided into 3 groups: the first (G1) made up of those who had not suffered from the COVID19 disease;a second group (G2) that had suffered from it, but did not report impairment of functional class (CF);and a third group (G3) who maintained dyspnea persistent 3 months after suffering from the disease. Analytical with NT-proBNP, echocardiogram, basal spirometry, and CPET were performed. None required hospital admission. Results: 36 subjects were included, distributed as follows: G1 (n = 14), G2 (n = 15), G3 (n = 7). The 3 groups had a similar age and BMI. None of the subjects presented alterations in baseline spirometry, neither structural heart disease in the echo, and nor relevant analytical alterations, being NT-proBNP less than 125 pg/ml in all of them. In relation to the response variables cardiovascular, statistical differences (p = 0.03) were observed in peak oxygen consumption predicted among the three groups (% predicted peak VO2), being significantly lower in the G3 subjects. In addition, a trend was observed -in absolute values- of peak VO2 to be lower in G3 -not significant probably due to the small sample size-. They were not objectified significant differences in PulseO2, nor in OUES. No patient presented alterations in the ventilatory efficiency parameters, or in final BR. Conclusions: In our sample, patients who remained with persistent dyspnea after COVID-19, have a lower functional capacity compared to healthy subjects of the same characteristics, and with respect to subjects who after COVID19 do not present any symptoms. This subjective deterioration of the FC can be objectively quantified using CPET, thus reaffirming its value in this context. (Figure Presented).
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Introduction: The current COVID-19 pandemic has led to significant changes in physical and mental health and has become a major challenge for cardiac rehabilitation (CR) programs. CR is an essential component in the treatment of heart failure (HF), as it improves cardiorespiratory fitness and quality of life, as well as reducing hospitalization rates. COVID-19 pandemic increased social isolation, and the CR centers were closed. Center-based CR requires the patient to travel to the hospital, which increases the risk of SARS-CoV-2 infection in this high-risk population. In this context, home-based CR can be an excellent strategy to reduce the physical and mental consequences of the social isolation imposed by the COVID-19 pandemic. Objective: To test the effectiveness of a home-based CR program on cardiorespiratory fitness and anxiety and depression levels in individuals with HF during covid-19 pandemic. Methods: Forty-two individuals with HF (age: 61.3±12.0;LVEF: 37.5±11.2) were included in this study. The exercise training program consisted in 12 weeks of combined exercise training (2x/week;60min/day, 60-80% VO2peak), with 4 supervised exercise sessions in the hospital context and the remaining at home. Patients were monitored using a heart rate monitor and weekly phone calls. The following parameters were evaluated: cardiorespiratory fitness through the 6-minute walk test (6MWT) and anxiety and depression levels through the Hospital Anxiety and Depression Scale (HADS). Results: After the home-based CR program, there was a significant increase in the 6MWT of 49 meters (95%IC: 38 to 60;p<0.001) and a significant decrease in anxiety levels of -1.12 points (95%CI: - 2.163 to -0.075 p=0.036). No significant changes were found in depression levels (p=0.954). Furthermore, the improvements in cardiorespiratory fitness were significantly associated with the reduction in the levels of anxiety (r= -0.281;p=0.028) and depression (r=: -0.278;p=0.030). Conclusions: The home-based CR program was able to improve cardiorespiratory fitness and this improvement was associated with a decrease in anxiety and depression levels in individuals with HF. The results suggest that home-based CR can be an important strategy to minimize the physical and mental impact induced by social isolation imposed by COVID-19 pandemic in HF patients.
ABSTRACT
Background: Cardiopulmonary symptoms and reduced exercise capacity can persist after SARS-CoV-2 infection. Mechanisms of post-acute sequelae of COVID-19 ("PASC" or "Long COVID") remain poorly understood. We hypothesized that systemic inflammation would be associated with reduced exercise capacity and pericardial/myocardial inflammation. Methods: As part of a COVID recovery cohort (NCT04362150) we assessed symptoms, biomarkers, and echocardiograms in adults >2 months after PCR-confirmed SARS-CoV-2 infection. In a subset, we performed cardiac magnetic resonance imaging (CMR), ambulatory rhythm monitoring (RM), and cardiopulmonary exercise testing (CPET) >12 months after acute infection. Associations between symptoms and oxygen consumption (VO2), cardiopulmonary parameters and biomarkers were evaluated using linear and logistic regression with adjustment for age, sex, BMI, and time since infection. Results: We studied 120 participants (median age 51, 42% female, and 47% had cardiopulmonary symptoms at median 7 months after acute infection). Elevated hsCRP was associated with symptoms (OR 1.32 per doubling, 95%CI 1.01-1.73, p=0.04). No differences in echocardiographic indices were found except for presence of pericardial effusions among those with symptoms (p=0.04). Of the subset (n=33) who underwent CMR at a median 17 months, all had normal cardiac function (LVEF 53-76%), 9 (27%) had pericardial effusions and none had findings suggestive of prior myocarditis. There were no differences on RM by symptoms. On CPET, 33% had reduced exercise capacity (peak VO2 <85% predicted). Individuals with symptoms had lower peak VO2 compared to those reporting recovery (28.4 vs 21.4 ml/kg/min, p=0.04, Figure). Elevated hsCRP was independently associated with lower peak VO2 after adjustment (-9.8 ml/kg/min per doubling, 95%CI-17.0 to-2.5;p=0.01, Figure). The predominant mechanism of reduced peak VO2 was chronotropic incompetence (HR 19% lower than predicted, 95%CI 11-26%;p<0.0001, Figure). Chronotropic incompetence on CPET correlated with lower peak HR during ambulatory RM (p<0.001). Conclusion: Persistent systemic inflammation (hsCRP) is associated with pericardial effusions and reduced exercise capacity > 1 year after acute SARS-CoV-2 infection. This finding appears to be driven mainly by chronotropic incompetence rather than respiratory compromise, cardiac pump dysfunction, or deconditioning. Evaluation of therapeutic strategies to target inflammation and/or chronotropy to alleviate PASC is urgently needed.
ABSTRACT
Recent studies have reported an impaired exercise response at cardiopulmonary exercise testing (CPET) during convalescence from coronavirus disease 2019 (COVID-19). In detail, these previous reports suggest the presence of functional limitations in a consistent proportion of COVID-19 survivors, in the absence of relevant alterations of ventilatory and gas exchange parameters at CPET. Therefore, deconditioning has been proposed as the main mechanism of the reduced peak oxygen uptake in this clinical setting. This interpretation of the results is supported by the evidence that deconditioning is a recognized aspect of the post-intensive care syndrome, with acute sarcopenia being frequently observed among COVID-19 survivors. Here, we hypothesized the role of endothelial dysfunction as a key pathogenic mechanism of the functional limitations of COVID-19, including multisystem deconditioning and subsequent exercise intolerance.