Evaluation of long-term sequelae by cardiopulmonary exercise testing 12 months after hospitalization for severe COVID-19
Background Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest. In the contex...
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| Vydáno v: | BMC Pulmonary Medicine Ročník 23; číslo 1; s. 13 |
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| Hlavní autoři: | , , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | angličtina |
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London
Springer Science and Business Media LLC
12.01.2023
BioMed Central BioMed Central Ltd BMC |
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| ISSN: | 1471-2466, 1471-2466 |
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| Abstract | Background
Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest. In the context of critical COVID-19, CPET is an ideal approach for assessing long term sequelae.
Methods
In this prospective single-center study, we performed CPET 12 months after symptom onset in 60 patients that had required intensive care unit treatment for a severe COVID-19 infection. Lung function at rest and chest computed tomography (CT) scan were also performed.
Results
Twelve months after severe COVID-19 pneumonia, dyspnea was the most frequently reported symptom although only a minority of patients had impaired respiratory function at rest. Mild ground-glass opacities, reticulations and bronchiectasis were the most common CT scan abnormalities. The majority of the patients (80%) had a peak O
2
uptake (V′O
2
) considered within normal limits (median peak predicted O
2
uptake (V′O
2
) of 98% [87.2–106.3]). Length of ICU stay remained an independent predictor of V′O
2
. More than half of the patients with a normal peak predicted V′O
2
showed ventilatory inefficiency during exercise with an abnormal increase of physiological dead space ventilation (VD/Vt) (median VD/VT of 0.27 [0.21–0.32] at anaerobic threshold (AT) and 0.29 [0.25–0.34] at peak) and a widened median peak alveolar-arterial gradient for O
2
(35.2 mmHg [31.2–44.8]. Peak PetCO
2
was significantly lower in subjects with an abnormal increase of VD/Vt (
p
= 0.001). Impairments were more pronounced in patients with dyspnea. Peak VD/Vt values were positively correlated with peak D-Dimer plasma concentrations from blood samples collected during ICU stay (r
2
= 0.12;
p
= 0.02) and to predicted diffusion capacity of the lung for carbon monoxide (D
LCO
) (r
2
= − 0.15;
p
= 0.01).
Conclusions
Twelve months after severe COVID-19 pneumonia, most of the patients had a peak V′O
2
considered within normal limits but showed ventilatory inefficiency during exercise with increased dead space ventilation that was more pronounced in patients with persistent dyspnea.
Trial registration
: NCT04519320 (19/08/2020). |
|---|---|
| AbstractList | Background Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest. In the context of critical COVID-19, CPET is an ideal approach for assessing long term sequelae. Methods In this prospective single-center study, we performed CPET 12 months after symptom onset in 60 patients that had required intensive care unit treatment for a severe COVID-19 infection. Lung function at rest and chest computed tomography (CT) scan were also performed. Results Twelve months after severe COVID-19 pneumonia, dyspnea was the most frequently reported symptom although only a minority of patients had impaired respiratory function at rest. Mild ground-glass opacities, reticulations and bronchiectasis were the most common CT scan abnormalities. The majority of the patients (80%) had a peak O.sub.2 uptake (V'O.sub.2) considered within normal limits (median peak predicted O.sub.2 uptake (V'O.sub.2) of 98% [87.2-106.3]). Length of ICU stay remained an independent predictor of V'O.sub.2. More than half of the patients with a normal peak predicted V'O.sub.2 showed ventilatory inefficiency during exercise with an abnormal increase of physiological dead space ventilation (VD/Vt) (median VD/VT of 0.27 [0.21-0.32] at anaerobic threshold (AT) and 0.29 [0.25-0.34] at peak) and a widened median peak alveolar-arterial gradient for O.sub.2 (35.2 mmHg [31.2-44.8]. Peak PetCO.sub.2 was significantly lower in subjects with an abnormal increase of VD/Vt (p = 0.001). Impairments were more pronounced in patients with dyspnea. Peak VD/Vt values were positively correlated with peak D-Dimer plasma concentrations from blood samples collected during ICU stay (r.sup.2 = 0.12; p = 0.02) and to predicted diffusion capacity of the lung for carbon monoxide (D.sub.LCO) (r.sup.2 = - 0.15; p = 0.01). Conclusions Twelve months after severe COVID-19 pneumonia, most of the patients had a peak V'O.sub.2 considered within normal limits but showed ventilatory inefficiency during exercise with increased dead space ventilation that was more pronounced in patients with persistent dyspnea. Trial registration: NCT04519320 (19/08/2020). Keywords: COVID-19, SARS-CoV-2, Acute respiratory distress syndrome, Cardiopulmonary exercise testing, Peak oxygen consumption, Pulmonary vascular disease Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest. In the context of critical COVID-19, CPET is an ideal approach for assessing long term sequelae. In this prospective single-center study, we performed CPET 12 months after symptom onset in 60 patients that had required intensive care unit treatment for a severe COVID-19 infection. Lung function at rest and chest computed tomography (CT) scan were also performed. Twelve months after severe COVID-19 pneumonia, dyspnea was the most frequently reported symptom although only a minority of patients had impaired respiratory function at rest. Mild ground-glass opacities, reticulations and bronchiectasis were the most common CT scan abnormalities. The majority of the patients (80%) had a peak O uptake (V'O ) considered within normal limits (median peak predicted O uptake (V'O ) of 98% [87.2-106.3]). Length of ICU stay remained an independent predictor of V'O . More than half of the patients with a normal peak predicted V'O showed ventilatory inefficiency during exercise with an abnormal increase of physiological dead space ventilation (VD/Vt) (median VD/VT of 0.27 [0.21-0.32] at anaerobic threshold (AT) and 0.29 [0.25-0.34] at peak) and a widened median peak alveolar-arterial gradient for O (35.2 mmHg [31.2-44.8]. Peak PetCO was significantly lower in subjects with an abnormal increase of VD/Vt (p = 0.001). Impairments were more pronounced in patients with dyspnea. Peak VD/Vt values were positively correlated with peak D-Dimer plasma concentrations from blood samples collected during ICU stay (r = 0.12; p = 0.02) and to predicted diffusion capacity of the lung for carbon monoxide (D ) (r = - 0.15; p = 0.01). Twelve months after severe COVID-19 pneumonia, most of the patients had a peak V'O considered within normal limits but showed ventilatory inefficiency during exercise with increased dead space ventilation that was more pronounced in patients with persistent dyspnea. NCT04519320 (19/08/2020). Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest. In the context of critical COVID-19, CPET is an ideal approach for assessing long term sequelae. In this prospective single-center study, we performed CPET 12 months after symptom onset in 60 patients that had required intensive care unit treatment for a severe COVID-19 infection. Lung function at rest and chest computed tomography (CT) scan were also performed. Twelve months after severe COVID-19 pneumonia, dyspnea was the most frequently reported symptom although only a minority of patients had impaired respiratory function at rest. Mild ground-glass opacities, reticulations and bronchiectasis were the most common CT scan abnormalities. The majority of the patients (80%) had a peak O.sub.2 uptake (V'O.sub.2) considered within normal limits (median peak predicted O.sub.2 uptake (V'O.sub.2) of 98% [87.2-106.3]). Length of ICU stay remained an independent predictor of V'O.sub.2. More than half of the patients with a normal peak predicted V'O.sub.2 showed ventilatory inefficiency during exercise with an abnormal increase of physiological dead space ventilation (VD/Vt) (median VD/VT of 0.27 [0.21-0.32] at anaerobic threshold (AT) and 0.29 [0.25-0.34] at peak) and a widened median peak alveolar-arterial gradient for O.sub.2 (35.2 mmHg [31.2-44.8]. Peak PetCO.sub.2 was significantly lower in subjects with an abnormal increase of VD/Vt (p = 0.001). Impairments were more pronounced in patients with dyspnea. Peak VD/Vt values were positively correlated with peak D-Dimer plasma concentrations from blood samples collected during ICU stay (r.sup.2 = 0.12; p = 0.02) and to predicted diffusion capacity of the lung for carbon monoxide (D.sub.LCO) (r.sup.2 = - 0.15; p = 0.01). Twelve months after severe COVID-19 pneumonia, most of the patients had a peak V'O.sub.2 considered within normal limits but showed ventilatory inefficiency during exercise with increased dead space ventilation that was more pronounced in patients with persistent dyspnea. Abstract Background Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest. In the context of critical COVID-19, CPET is an ideal approach for assessing long term sequelae. Methods In this prospective single-center study, we performed CPET 12 months after symptom onset in 60 patients that had required intensive care unit treatment for a severe COVID-19 infection. Lung function at rest and chest computed tomography (CT) scan were also performed. Results Twelve months after severe COVID-19 pneumonia, dyspnea was the most frequently reported symptom although only a minority of patients had impaired respiratory function at rest. Mild ground-glass opacities, reticulations and bronchiectasis were the most common CT scan abnormalities. The majority of the patients (80%) had a peak O2 uptake (V′O2) considered within normal limits (median peak predicted O2 uptake (V′O2) of 98% [87.2–106.3]). Length of ICU stay remained an independent predictor of V′O2. More than half of the patients with a normal peak predicted V′O2 showed ventilatory inefficiency during exercise with an abnormal increase of physiological dead space ventilation (VD/Vt) (median VD/VT of 0.27 [0.21–0.32] at anaerobic threshold (AT) and 0.29 [0.25–0.34] at peak) and a widened median peak alveolar-arterial gradient for O2 (35.2 mmHg [31.2–44.8]. Peak PetCO2 was significantly lower in subjects with an abnormal increase of VD/Vt (p = 0.001). Impairments were more pronounced in patients with dyspnea. Peak VD/Vt values were positively correlated with peak D-Dimer plasma concentrations from blood samples collected during ICU stay (r2 = 0.12; p = 0.02) and to predicted diffusion capacity of the lung for carbon monoxide (DLCO) (r2 = − 0.15; p = 0.01). Conclusions Twelve months after severe COVID-19 pneumonia, most of the patients had a peak V′O2 considered within normal limits but showed ventilatory inefficiency during exercise with increased dead space ventilation that was more pronounced in patients with persistent dyspnea. Trial registration: NCT04519320 (19/08/2020). Background Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest. In the context of critical COVID-19, CPET is an ideal approach for assessing long term sequelae. Methods In this prospective single-center study, we performed CPET 12 months after symptom onset in 60 patients that had required intensive care unit treatment for a severe COVID-19 infection. Lung function at rest and chest computed tomography (CT) scan were also performed. Results Twelve months after severe COVID-19 pneumonia, dyspnea was the most frequently reported symptom although only a minority of patients had impaired respiratory function at rest. Mild ground-glass opacities, reticulations and bronchiectasis were the most common CT scan abnormalities. The majority of the patients (80%) had a peak O 2 uptake (V′O 2 ) considered within normal limits (median peak predicted O 2 uptake (V′O 2 ) of 98% [87.2–106.3]). Length of ICU stay remained an independent predictor of V′O 2 . More than half of the patients with a normal peak predicted V′O 2 showed ventilatory inefficiency during exercise with an abnormal increase of physiological dead space ventilation (VD/Vt) (median VD/VT of 0.27 [0.21–0.32] at anaerobic threshold (AT) and 0.29 [0.25–0.34] at peak) and a widened median peak alveolar-arterial gradient for O 2 (35.2 mmHg [31.2–44.8]. Peak PetCO 2 was significantly lower in subjects with an abnormal increase of VD/Vt ( p = 0.001). Impairments were more pronounced in patients with dyspnea. Peak VD/Vt values were positively correlated with peak D-Dimer plasma concentrations from blood samples collected during ICU stay (r 2 = 0.12; p = 0.02) and to predicted diffusion capacity of the lung for carbon monoxide (D LCO ) (r 2 = − 0.15; p = 0.01). Conclusions Twelve months after severe COVID-19 pneumonia, most of the patients had a peak V′O 2 considered within normal limits but showed ventilatory inefficiency during exercise with increased dead space ventilation that was more pronounced in patients with persistent dyspnea. Trial registration : NCT04519320 (19/08/2020). Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest. In the context of critical COVID-19, CPET is an ideal approach for assessing long term sequelae.BACKGROUNDCardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses to exercise which are not adequately reflected through the measurement of individual organ system function at rest. In the context of critical COVID-19, CPET is an ideal approach for assessing long term sequelae.In this prospective single-center study, we performed CPET 12 months after symptom onset in 60 patients that had required intensive care unit treatment for a severe COVID-19 infection. Lung function at rest and chest computed tomography (CT) scan were also performed.METHODSIn this prospective single-center study, we performed CPET 12 months after symptom onset in 60 patients that had required intensive care unit treatment for a severe COVID-19 infection. Lung function at rest and chest computed tomography (CT) scan were also performed.Twelve months after severe COVID-19 pneumonia, dyspnea was the most frequently reported symptom although only a minority of patients had impaired respiratory function at rest. Mild ground-glass opacities, reticulations and bronchiectasis were the most common CT scan abnormalities. The majority of the patients (80%) had a peak O2 uptake (V'O2) considered within normal limits (median peak predicted O2 uptake (V'O2) of 98% [87.2-106.3]). Length of ICU stay remained an independent predictor of V'O2. More than half of the patients with a normal peak predicted V'O2 showed ventilatory inefficiency during exercise with an abnormal increase of physiological dead space ventilation (VD/Vt) (median VD/VT of 0.27 [0.21-0.32] at anaerobic threshold (AT) and 0.29 [0.25-0.34] at peak) and a widened median peak alveolar-arterial gradient for O2 (35.2 mmHg [31.2-44.8]. Peak PetCO2 was significantly lower in subjects with an abnormal increase of VD/Vt (p = 0.001). Impairments were more pronounced in patients with dyspnea. Peak VD/Vt values were positively correlated with peak D-Dimer plasma concentrations from blood samples collected during ICU stay (r2 = 0.12; p = 0.02) and to predicted diffusion capacity of the lung for carbon monoxide (DLCO) (r2 = - 0.15; p = 0.01).RESULTSTwelve months after severe COVID-19 pneumonia, dyspnea was the most frequently reported symptom although only a minority of patients had impaired respiratory function at rest. Mild ground-glass opacities, reticulations and bronchiectasis were the most common CT scan abnormalities. The majority of the patients (80%) had a peak O2 uptake (V'O2) considered within normal limits (median peak predicted O2 uptake (V'O2) of 98% [87.2-106.3]). Length of ICU stay remained an independent predictor of V'O2. More than half of the patients with a normal peak predicted V'O2 showed ventilatory inefficiency during exercise with an abnormal increase of physiological dead space ventilation (VD/Vt) (median VD/VT of 0.27 [0.21-0.32] at anaerobic threshold (AT) and 0.29 [0.25-0.34] at peak) and a widened median peak alveolar-arterial gradient for O2 (35.2 mmHg [31.2-44.8]. Peak PetCO2 was significantly lower in subjects with an abnormal increase of VD/Vt (p = 0.001). Impairments were more pronounced in patients with dyspnea. Peak VD/Vt values were positively correlated with peak D-Dimer plasma concentrations from blood samples collected during ICU stay (r2 = 0.12; p = 0.02) and to predicted diffusion capacity of the lung for carbon monoxide (DLCO) (r2 = - 0.15; p = 0.01).Twelve months after severe COVID-19 pneumonia, most of the patients had a peak V'O2 considered within normal limits but showed ventilatory inefficiency during exercise with increased dead space ventilation that was more pronounced in patients with persistent dyspnea.CONCLUSIONSTwelve months after severe COVID-19 pneumonia, most of the patients had a peak V'O2 considered within normal limits but showed ventilatory inefficiency during exercise with increased dead space ventilation that was more pronounced in patients with persistent dyspnea.NCT04519320 (19/08/2020).TRIAL REGISTRATIONNCT04519320 (19/08/2020). |
| ArticleNumber | 13 |
| Audience | Academic |
| Author | Sofia Noureddine Ophélie Ritter Virginie Westeel Pauline Dolla Pauline Roux-Claudé Cindy Barnig Lucie Laurent Frédéric Claudé Guillaume Eberst Sinan Karaer |
| Author_xml | – sequence: 1 givenname: Sofia surname: Noureddine fullname: Noureddine, Sofia organization: Department of Chest Disease, University Hospital Besançon – sequence: 2 givenname: Pauline surname: Roux-Claudé fullname: Roux-Claudé, Pauline organization: Department of Chest Disease, University Hospital Besançon – sequence: 3 givenname: Lucie surname: Laurent fullname: Laurent, Lucie organization: Department of Chest Disease, University Hospital Besançon – sequence: 4 givenname: Ophélie surname: Ritter fullname: Ritter, Ophélie organization: Department of Chest Disease, University Hospital Besançon – sequence: 5 givenname: Pauline surname: Dolla fullname: Dolla, Pauline organization: Department of Chest Disease, University Hospital Besançon – sequence: 6 givenname: Sinan surname: Karaer fullname: Karaer, Sinan organization: Department of Chest Disease, University Hospital Besançon – sequence: 7 givenname: Frédéric surname: Claudé fullname: Claudé, Frédéric organization: Department of Chest Disease, University Hospital Besançon – sequence: 8 givenname: Guillaume surname: Eberst fullname: Eberst, Guillaume organization: Department of Chest Disease, University Hospital Besançon, Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France and UMR 1098, University of Franche-Comté – sequence: 9 givenname: Virginie surname: Westeel fullname: Westeel, Virginie organization: Department of Chest Disease, University Hospital Besançon, Methodology and Quality of Life in Oncology Unit, University Hospital, Besançon, France and UMR 1098, University of Franche-Comté – sequence: 10 givenname: Cindy surname: Barnig fullname: Barnig, Cindy email: cindy.barnig@univ-fcomte.fr organization: Department of Chest Disease, University Hospital Besançon, UMR1098, University of Franche-Comté, INSERM, EFS BFC |
| BackLink | https://cir.nii.ac.jp/crid/1873398392353945984$$DView record in CiNii https://www.ncbi.nlm.nih.gov/pubmed/36635717$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1016_j_arbres_2024_05_021 crossref_primary_10_1186_s12890_024_03070_1 crossref_primary_10_3390_diagnostics14060621 crossref_primary_10_1136_thorax_2023_221096 crossref_primary_10_1159_000540598 crossref_primary_10_1002_hsr2_70507 crossref_primary_10_1183_23120541_00234_2023 crossref_primary_10_1371_journal_pone_0296707 crossref_primary_10_36290_aim_2025_006 |
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| Keywords | COVID-19 Acute respiratory distress syndrome Pulmonary vascular disease SARS-CoV-2 Peak oxygen consumption Cardiopulmonary exercise testing |
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Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and... Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and metabolic responses... Background Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and... Abstract Background Cardiopulmonary exercise testing (CPET) is an important clinical tool that provides a global assessment of the respiratory, circulatory and... |
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| SubjectTerms | Acute respiratory distress syndrome Bacterial pneumonia Cardiopulmonary exercise testing Care and treatment Complications and side effects COVID-19 Critical Care Medicine Diagnosis Disease Progression Diseases of the respiratory system Dyspnea Exercise Test Exercise Test - methods Exercise tests Exercise Tolerance Hospitalization Humans Intensive Internal Medicine Medicine Medicine & Public Health Methods Patient outcomes Peak oxygen consumption Pneumology/Respiratory System Pneumonia Prospective Studies Pulmonary function tests Pulmonary vascular disease RC705-779 Respiratory intensive care SARS-CoV-2 |
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| Title | Evaluation of long-term sequelae by cardiopulmonary exercise testing 12 months after hospitalization for severe COVID-19 |
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