Symptom Persistence Despite Improvement in Cardiopulmonary Health - Insights from longitudinal CMR, CPET and lung function testing post-COVID-19.

Autor: 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.; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom., Tunnicliffe EM; 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., Petousi N; Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.; Department of Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom., Lewandowski AJ; 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., Xie C; Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom.; Department of Radiology, 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.; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom., Samat AHA; 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.; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom., Evans RA; NIHR Biomedical Research Centre (Respiratory theme), University Hospitals of Leicester NHS Trust, Leicester, UK.; Department of Respiratory Science, University of Leicester, Leicester, UK., Brightling CE; NIHR Biomedical Research Centre (Respiratory theme), University Hospitals of Leicester NHS Trust, Leicester, UK.; Department of Respiratory Science, University of Leicester, Leicester, UK., Ho LP; Weatherall Institute of Molecular Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.; Department of Respiratory Medicine, 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 Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom.; Department of Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom., Holdsworth D; Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom.; Department of Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom., Ferreira VM; 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.; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom., Neubauer S; 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.; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.; Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom., Raman B; 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.; Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.; Radcliffe Department of Medicine, British Heart Foundation Centre for Research Excellence, University of Oxford, Oxford, United Kingdom.
Jazyk: angličtina
Zdroj: EClinicalMedicine [EClinicalMedicine] 2021 Nov; Vol. 41, pp. 101159. Date of Electronic Publication: 2021 Oct 20.
DOI: 10.1016/j.eclinm.2021.101159
Abstrakt: 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 14 th March - 25 th 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 T 1 (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 (pV̇O 2 ) on CPET. By 6 months, 52% of patients remained symptomatic. On CMR, indexed right ventricular (RV) end-diastolic volume (-4·3 mls/m 2 , P =0·005) decreased and RV ejection fraction (+3·2%, P =0·0003) increased. Native T 1 and LGE improved and was comparable to controls. Lung parenchymal abnormalities and peak V̇O 2 , although better, were abnormal in patients versus controls. 31% had reduced pV̇O 2 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.
Competing Interests: MC reports a grant from the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre. EMT reports a grant from the NIHR Oxford Biomedical Research Centre and is a shareholder in Perspectum. AL is a shareholder in Perspectum. SKP acknowledges support from the British Heart Foundation (BHF) Centre of Research Excellence and the NIHR Oxford Biomedical Research Centre at the Oxford University Hospitals, University of Oxford, UK. SKP has a US patent 61/387,591 licensed to Siemens and US patents 61/630,508 and 61-630,510 licensed to Perspectum. RAE reports a grant from the NIHR/Medical Research Council (MRC) for the PHOSP-COVID study. VMF reports grants from the BHF and the NIHR Oxford Biomedical Research Centre. SN reports grants from the NIHR Oxford Biomedical Research Centre, UK Research and Innovation, BHF and is a shareholder in Perspectum. SN was a board member and consultant to Perspectum until 2019. SN has patents ‘Multi-parametric magnetic resonance diagnosis & staging of liver disease’ and ‘System and methods for gated mapping of T1 values in abdominal visceral organs’ licensed to Perspectum. BR reports grants from the Oxford BHF Centre for Research Excellence (RE/18/3/34214), the NIHR Oxford Biomedical Research Centre and the United Kingdom Research Innovation Award. All other authors do not have relationships with industry or funding sources to declare.
(© 2021 The Authors.)
Databáze: MEDLINE
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