Cardiopulmonary function post-COVID returns to normal for most

The majority of people hospitalised with COVID-19 have normal exercise capacity one year after discharge, finds a study that experts say offers reassurance for clinicians and their patients. 

In the prospective multicentre trial [link here] people hospitalised with COVID in the first phase of the pandemic performed a treadmill cardiopulmonary exercise test (CPET) at 3 (n=180) and 12 months (n=177) after discharge. Their results were then compared to matched controls who had not contracted the virus. 

At 3 and 12-months, 64 patients (34%) and 40 patients (23%), respectively demonstrated depressed peak exercise aerobic capacity (i.e. peak VO2 ≤80% predicted). Among those with depressed peak VO2 at months 3 and 12, nearly half (48%) were “deconditioned”, the Norwegian study authors reported in the European Respiratory Journal. 

And in patients with exercise intolerance, circulatory limitations were more common than ventilatory limitations, the study showed.

The remaining patients with reduced peak VO2 at three months were reported to have a circulatory limitation (28%), ventilatory limitation (17%), and dysfunctional breathing (7%) while at 12 months, circulatory (33%) and ventilatory limitations (19%) were the other reported reasons for depressed peak VO2.

At 12 months, the authors noted that the majority of patients had regained normal exercise capacity and the prevalence of exercise intolerance was reduced to every fourth patient. 

“Our study was limited to non-invasive methods, thus we cannot explain all aspects of the mechanisms interfering with exercise capacity. However, deconditioning due to inactivity seems to be the most prevalent exercise limitation,” they wrote. 

According to an accompanying editorial [link here] the results of the trial “undoubtedly” provides some reassurance to post-COVID-19 patients and treating physicians but the fact that the trial did not offer a comprehensive patho-physiological rationale for persistent exertional intolerance was a limitation. 

“For the patients with Post-Acute Sequelae of SARS-CoV-2 infection (PASC) syndrome their ongoing symptomatology persists and may even have implications beyond exercise intolerance”, they wrote. 

 “While the interval improvement in aerobic exercise capacity reported in the study … offers some reassurance, future studies focused on accurate cardio-pulmonary-systemic vascular hemodynamic assessment coupled with advanced -omics molecular phenotyping is warranted to help better understand the patho-mechanistic process that begets PASC so help develop therapeutic options for our patients,” they added.

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