Cardiovascular evaluation using exercise testing performed with face masks during the COVID-19 pandemic.

OBJECTIVE: COVID-19 pandemic is associated with high incidence and fatality, however, non-communicable diseases remain a global public health problem with even greater morbidity and mortality. At present, there is a lag in diagnosis and treatment of patients with heart disease, particularly the performance of exercise testing (ET), due to the fear of aerosol generation and viral dissemination. Although some centers carry out the tests with the use of masks, the information is still superficial and preliminary. The objective of the study was to describe the ergometric performance observed when performing exercise tests during the COVID-19 (PANDEMIC-G) pandemic and to highlight the differences with those results carried out in another time, when there was no COVID-19 (NO PANDEMIC). METHOD: A cross-sectional study was carried out. PANDEMIC-G patients underwent ET between March 2020 and December 2020, once a biological triage was done and all of them wore N95 masks. They were compared to NO PANDEMIC patients that performed an ET between March 2019 and December 2019. Demographic and ergometric variables were presented and analyzed according to their type. All p < 0.05 were considered stochastically significant. RESULTS: A total of 361 ET were studied: 209 (58%) belonged to NO PANDEMIC and 152 (42%) to PANDEMIC-G. The number of ET stopped by dyspnea was greater in PANDEMIC-G (117) than in NO PANDEMIC (8). Exercise tolerance did not show significant changes. Systolic blood pressure, double product, and myocardial oxygen utilization were higher in PANDEMIC-G ET (p < 0.01). CONCLUSIONS: In the COVID-era, fewer stress tests were performed, which were suspended more frequently due to dyspnea. Higher values of systolic blood pressure and myocardial oxygen utilization were observed in PANDEMIC-G as well.

OBJETIVO: La pandemia de COVID-19 se asocia con una alta incidencia y letalidad; sin embargo, las enfermedades no transmisibles siguen siendo un problema de salud pública mundial con una morbilidad y mortalidad aún mayores. Actualmente, existe un retraso en el diagnóstico y tratamiento de los pacientes con enfermedades cardíacas, particularmente en la realización de la prueba de esfuerzo (PE), debido al temor a la generación de aerosoles y la diseminación viral. Aunque algunos centros realizan las pruebas con el uso de tapabocas, la información aún es superficial y preliminar. El objetivo del estudio fue describir el desempeño ergométrico observado al realizar pruebas de ejercicio durante la pandemia COVID-19 (PANDEMIC-G) y remarcar las diferencias con las pruebas realizadas antes de ella (NO PANDEMIC). MÉTODO: Se realizó un estudio transversal. Los pacientes con PANDEMIC-G se sometieron a PE entre marzo y diciembre de 2020, una vez que se realizó un triaje biológico y todos usaron tapabocas N95. Fueron comparados con pacientes NO PANDEMIC, que realizaron una PE entre marzo y diciembre de 2019. Las variables se presentaron y analizaron según su tipo. Todos los valores de p inferiores a 0.05 se consideraron estocásticamente significativos. RESULTADOS: Se estudiaron un total de 361 PE, donde 209 (58%) pertenecían a NO PANDEMIC y 152 (42%) a PANDEMIC-G. El número de PE detenidas por disnea fue mayor en PANDEMIC-G (n = 117) que en NO PANDEMIC (n = 8). La tolerancia al ejercicio no mostró cambios significativos. La presión arterial sistólica, el producto doble y la utilización de oxígeno del miocardio fueron mayores en las PE en el PANDEMIC-G (p < 0.01). CONCLUSIONES: En la era COVID se realizaron menos pruebas de esfuerzo, que se suspendieron con mayor frecuencia por disnea. También se observaron valores más altos de presión arterial sistólica y utilización de oxígeno del miocardio en PANDEMIC-G.

Direct and indirect evidence of efficacy and safety of rapid exercise tests for exertional desaturation in Covid-19: a rapid systematic review.

BACKGROUND: Even when resting pulse oximetry is normal in the patient with acute Covid-19, hypoxia can manifest on exertion. We summarise the literature on the performance of different rapid tests for exertional desaturation and draw on this evidence base to provide guidance in the context of acute Covid-19. MAIN RESEARCH QUESTIONS: 1. What exercise tests have been used to assess exertional hypoxia at home or in an ambulatory setting in the context of Covid-19 and to what extent have they been validated? 2. What exercise tests have been used to assess exertional hypoxia in other lung conditions, to what extent have they been validated and what is the applicability of these studies to acute Covid-19? METHOD: AMED, CINAHL, EMBASE MEDLINE, Cochrane and PubMed using LitCovid, Scholar and Google databases were searched to September 2020. Studies where participants had Covid-19 or another lung disease and underwent any form of exercise test which was compared to a reference standard were eligible. Risk of bias was assessed using QUADAS 2. A protocol for the review was published on the Medrxiv database. RESULTS: Of 47 relevant papers, 15 were empirical studies, of which 11 described an attempt to validate one or more exercise desaturation tests in lung diseases other than Covid-19. In all but one of these, methodological quality was poor or impossible to fully assess. None had been designed as a formal validation study (most used simple tests of correlation). Only one validation study (comparing a 1-min sit-to-stand test [1MSTST] with reference to the 6-min walk test [6MWT] in 107 patients with interstitial lung disease) contained sufficient raw data for us to calculate the sensitivity (88%), specificity (81%) and positive and negative predictive value (79% and 89% respectively) of the 1MSTST. The other 4 empirical studies included two predictive studies on patients with Covid-19, and two on HIV-positive patients with suspected pneumocystis pneumonia. We found no studies on the 40-step walk test (a less demanding test that is widely used in clinical practice to assess Covid-19 patients). Heterogeneity of study design precluded meta-analysis. DISCUSSION: Exertional desaturation tests have not yet been validated in patients with (or suspected of having) Covid-19. A stronger evidence base exists for the diagnostic accuracy of the 1MSTST in chronic long-term pulmonary disease; the relative intensity of this test may raise safety concerns in remote consultations or unstable patients. The less strenuous 40-step walk test should be urgently evaluated.

Maximizing Participant and Staff Safety During Assessment of Physical Function in the COVID-19 Era.

Physical performance measures, including cardiopulmonary exercise testing (CPXT), are widely used in geriatric practice and aging research. Theoretically, research participants and study personnel could get infected in the closed environment of the exercise laboratory by contact with respiratory droplets from an infected person, by breathing virus-laden aerosols, or by touching fomites. Older adults are at increased risk of developing more severe disease and of dying from SARS-CoV-2 infection. This special article offers guidance-informed by a synthesis of scientific data and recommendations of the CDC and WHO-on procedures that can be implemented in exercise laboratories to minimize risk of SARS-CoV-2 and other respiratory infections. Most tests of physical function (e.g., gait speed, Short Physical Performance Battery) are not aerosol-generating and are associated with only a small increase in minute ventilation; in contrast, CPXT markedly increases minute ventilation and is potentially aerosol-generating. Researchers should evaluate the benefit-to-risk ratio of information gained from the laboratory assessment versus the risk of SARS-CoV2 infection. Risk mitigation strategies described here fall into four categories: personal hygiene and the use of personal protective equipment; standardized screening; reconfiguration of laboratory space; and optimization of laboratory ventilation. The proposed safety measures are not intended to replace institutional policy, state, or federal guidelines; they may not apply to all settings and are expected to evolve as more definitive information becomes available. These practical measures to maximize protection against SARS-CoV2 infection can help maximize participant and staff safety, reduce anxiety, and facilitate protocol adherence, and study integrity.