Exercise intolerance in post-coronavirus disease 2019 survivors after hospitalisation

• Autor(a) principal: Lafetá, Mariana L.
• Data de Publicação: 2023
• Outros Autores: Souza, Vitor C., Menezes, Thaís C. F., Verrastro, Carlos G. Y., Mancuso, Frederico J., Albuquerque, André Luis P., Tanni, Suzana E. [UNESP], Izbicki, Meyer, Carlstron, Júlio P., Nery, Luiz Eduardo, Oliveira, Rudolf K. F., Sperandio, Priscila A., Ferreira, Eloara V. M.
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UNESP
• Texto Completo: http://dx.doi.org/10.1183/23120541.00538-2022; http://hdl.handle.net/11449/248910

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-tosevere/ 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.