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Symptom Persistence Despite Improvement in Cardiopulmonary Health - Insights from longitudinal CMR, CPET and lung function testing post-COVID-19.
Cassar, Mark Philip; Tunnicliffe, Elizabeth M; Petousi, Nayia; Lewandowski, Adam J; Xie, Cheng; Mahmod, Masliza; Samat, Azlan Helmy Abd; Evans, Rachael A; Brightling, Christopher E; Ho, Ling-Pei; Piechnik, Stefan K; Talbot, Nick P; Holdsworth, David; Ferreira, Vanessa M; Neubauer, Stefan; Raman, Betty.
  • Cassar MP; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom.
  • Tunnicliffe EM; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
  • Petousi N; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom.
  • Lewandowski AJ; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
  • Xie C; Department of Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
  • Mahmod M; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom.
  • Samat AHA; Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom.
  • Evans RA; Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
  • Brightling CE; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom.
  • Ho LP; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
  • Piechnik SK; Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom.
  • Talbot NP; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
  • Holdsworth D; NIHR Biomedical Research Centre (Respiratory theme), University Hospitals of Leicester NHS Trust, Leicester, UK.
  • Ferreira VM; Department of Respiratory Science, University of Leicester, Leicester, UK.
  • Neubauer S; NIHR Biomedical Research Centre (Respiratory theme), University Hospitals of Leicester NHS Trust, Leicester, UK.
  • Raman B; Department of Respiratory Science, University of Leicester, Leicester, UK.
EClinicalMedicine ; 41: 101159, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1471951
Preprint
This scientific journal article is probably based on a previously available preprint. It has been identified through a machine matching algorithm, human confirmation is still pending.
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ABSTRACT

BACKGROUND:

The longitudinal trajectories of cardiopulmonary abnormalities and symptoms following infection with coronavirus disease (COVID-19) are unclear. We sought to describe their natural history in previously hospitalised patients, compare this with controls, and assess the relationship between symptoms and cardiopulmonary impairment at 6 months post-COVID-19.

METHODS:

Fifty-eight patients and thirty matched controls (single visit), recruited between 14th March - 25th May 2020, underwent symptom-questionnaires, cardiac and lung magnetic resonance imaging (CMR), cardiopulmonary exercise test (CPET), and spirometry at 3 months following COVID-19. Of them, forty-six patients returned for follow-up assessments at 6 months.

FINDINGS:

At 2-3 months, 83% of patients had at least one cardiopulmonary symptom versus 33% of controls. Patients and controls had comparable biventricular volumes and function. Native cardiac T1 (marker of fibroinflammation) and late gadolinium enhancement (LGE, marker of focal fibrosis) were increased in patients at 2-3 months. Sixty percent of patients had lung parenchymal abnormalities on CMR and 55% had reduced peak oxygen consumption (pV̇O2) on CPET. By 6 months, 52% of patients remained symptomatic. On CMR, indexed right ventricular (RV) end-diastolic volume (-4·3 mls/m2, P=0·005) decreased and RV ejection fraction (+3·2%, P=0·0003) increased. Native T1 and LGE improved and was comparable to controls. Lung parenchymal abnormalities and peak V̇O2, although better, were abnormal in patients versus controls. 31% had reduced pV̇O2 secondary to symptomatic limitation and muscular impairment. Cardiopulmonary symptoms in patients did not associate with CMR, lung function, or CPET measures.

INTERPRETATION:

In patients, cardiopulmonary abnormalities improve over time, though some measures remain abnormal relative to controls. Persistent symptoms at 6 months post-COVID-19 did not associate with objective measures of cardiopulmonary health.

FUNDING:

The authors' work was supported by the NIHR Oxford Biomedical Research Centre, Oxford British Heart Foundation (BHF) Centre of Research Excellence (RE/18/3/34214), United Kingdom Research Innovation and Wellcome Trust. This project is part of a tier 3 study (C-MORE) within the collaborative research programme entitled PHOSP-COVID Post-hospitalization COVID-19 study a national consortium to understand and improve long-term health outcomes, funded by the Medical Research Council and Department of Health and Social Care/National Institute for Health Research Grant (MR/V027859/1) ISRCTN number 10980107.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Language: English Journal: EClinicalMedicine Year: 2021 Document Type: Article Affiliation country: J.eclinm.2021.101159

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Observational study / Prognostic study Topics: Long Covid Language: English Journal: EClinicalMedicine Year: 2021 Document Type: Article Affiliation country: J.eclinm.2021.101159