Exercise intolerance in post-coronavirus disease 2019 survivors after hospitalisation.

Autor:	Lafetá ML; Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil., Souza VC; Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil., Menezes TCF; Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil., Verrastro CGY; Radiology Division, UNIFESP, Sao Paulo, Brazil., Mancuso FJ; Division of Cardiology, UNIFESP, Sao Paulo, Brazil., Albuquerque ALP; Pulmonary Division, Heart Institute (INCOR), Clinical Hospital HCFMUSP, Faculty of the Medicine University of Sao Paulo, Sao Paulo, Brazil.; Sírio-Libanês Teaching and Research Institute, Sao Paulo, Brazil., Tanni SE; Division of Internal Medicine of Botucatu Medical School, São Paulo State University (UNESP), Botucatu, Brazil., Izbicki M; Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil., Carlstron JP; Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil., Nery LE; Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil., Oliveira RKF; Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil., Sperandio PA; Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil., Ferreira EVM; Pulmonary Function and Clinical Exercise Physiology Unit (SEFICE), Division of Respiratory Diseases, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil.
Jazyk:	angličtina
Zdroj:	ERJ open research [ERJ Open Res] 2023 May 22; Vol. 9 (3). Date of Electronic Publication: 2023 May 22 (Print Publication: 2023).
DOI:	10.1183/23120541.00538-2022
Abstrakt:	Rationale: Post-coronavirus disease 2019 (COVID-19) survivors frequently have dyspnoea that can lead to exercise intolerance and lower quality of life. Despite recent advances, the pathophysiological mechanisms of exercise intolerance in the post-COVID-19 patients remain incompletely characterised. The objectives of the present study were to clarify the mechanisms of exercise intolerance in post-COVID-19 survivors after hospitalisation. Methods: This prospective study evaluated consecutive patients previously hospitalised due to moderate-to-severe/critical COVID-19. Within mean±sd 90±10 days of onset of acute COVID-19 symptoms, patients underwent a comprehensive cardiopulmonary assessment, including cardiopulmonary exercise testing with earlobe arterialised capillary blood gas analysis. Measurements and Main Results: 87 patients were evaluated; mean±sd peak oxygen consumption was 19.5±5.0 mL·kg -1 ·min -1 , and the tertiles were ≤17.0, 17.1-22.2 and ≥22.3 mL·kg -1 ·min -1 . Hospitalisation severity was similar among the three groups; however, at the follow-up visit, patients with peak oxygen consumption ≤17.0 mL·kg -1 ·min -1 reported a greater sensation of dyspnoea, along with indices of impaired pulmonary function, and abnormal ventilatory, gas-exchange and metabolic responses during exercise compared to patients with peak oxygen consumption >17 mL·kg -1 ·min -1 . By multivariate logistic regression analysis (receiver operating characteristic curve analysis) adjusted for age, sex and prior pulmonary embolism, a peak dead space fraction of tidal volume ≥29 and a resting forced vital capacity ≤80% predicted were independent predictors of reduced peak oxygen consumption. Conclusions: Exercise intolerance in the post-COVID-19 survivors was related to a high dead space fraction of tidal volume at peak exercise and a decreased resting forced vital capacity, suggesting that both pulmonary microcirculation injury and ventilatory impairment could influence aerobic capacity in this patient population. Competing Interests: Conflict of interest: M.L. Lafetá has nothing to disclose. Conflict of interest: V.C. Souza has nothing to disclose. Conflict of interest: T.C.F. Menezes has nothing to disclose. Conflict of interest: C.G.Y. Verrastro has nothing to disclose. Conflict of interest: F.J. Mancuso has nothing to disclose. Conflict of interest: A.L.P. Albuquerque has nothing to disclose. Conflict of interest: S.E. Tanni is President of the Sao Paulo Thoracic Society outside the submitted work. Conflict of interest: M. Izbicki has nothing to disclose. Conflict of interest: J.P. Carlstron has nothing to disclose. Conflict of interest: L.E. Nery has nothing to disclose. Conflict of interest: R.K.F. Oliveira report grants from the National Council for Scientific and Technological Development (CNPq), Brazil (grant 313284/2021-0), and personal fees from Janssen Brazil, outside the submitted work. Conflict of interest: P.A. Sperandio has nothing to disclose. Conflict of interest: E.V.M. Ferreira reports speaker fees from Janssen, and personal fees from Aché, AstraZeneca, Bayer, Boeringer, GSK, Novo Nordisk, Jassen-Cilag, J&J and Zambon, outside the submitted work. (Copyright ©The authors 2023.)
Databáze:	MEDLINE
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