Use of Cardiopulmonary Stress Testing for Patients With Unexplained Dyspnea Post–Coronavirus Disease,JACC: Heart Failure

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Use of Cardiopulmonary Stress Testing for Patients With Unexplained Dyspnea Post–Coronavirus Disease
JACC: Heart Failure ( IF 10.3 ) Pub Date : 2021-11-29 , DOI: 10.1016/j.jchf.2021.10.002
Donna M Mancini ₁ , Danielle L Brunjes ₂ , Anuradha Lala ₁ , Maria Giovanna Trivieri ₂ , Johanna P Contreras ₂ , Benjamin H Natelson ₃

Affiliation

Objectives

The authors used cardiopulmonary exercise testing (CPET) to define unexplained dyspnea in patients with post-acute sequelae of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection (PASC). We assessed participants for criteria to diagnose myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Background

Approximately 20% of patients who recover from coronavirus disease (COVID) remain symptomatic. This syndrome is named PASC. Its etiology is unclear. Dyspnea is a frequent symptom.

Methods

The authors performed CPET and symptom assessment for ME/CFS in 41 patients with PASC 8.9 ± 3.3 months after COVID. All patients had normal pulmonary function tests, chest X-ray, and chest computed tomography scans. Peak oxygen consumption (peak VO₂), slope of minute ventilation to CO₂ production (VE/VCO₂ slope), and end tidal pressure of CO₂ (PetCO₂) were measured. Ventilatory patterns were reviewed with dysfunctional breathing defined as rapid erratic breathing.

Results

Eighteen men and 23 women (average age: 45 ± 13 years) were studied. Left ventricular ejection fraction was 59% ± 9%. Peak VO₂ averaged 20.3 ± 7 mL/kg/min (77% ± 21% predicted VO₂). VE/VCO₂ slope was 30 ± 7. PetCO₂ at rest was 33.5 ± 4.5 mm Hg. Twenty-four patients (58.5%) had a peak VO₂ <80% predicted. All patients with peak VO₂ <80% had a circulatory limitation to exercise. Fifteen of 17 patients with normal peak VO₂ had ventilatory abnormalities including peak respiratory rate >55 (n = 3) or dysfunctional breathing (n = 12). For the whole cohort, 88% of patients (n = 36) had ventilatory abnormalities with dysfunctional breathing (n = 26), increased VE/VCO₂ (n = 17), and/or hypocapnia PetCO₂ <35 (n = 25). Nineteen patients (46%) met criteria for ME/CFS.

Conclusions

Circulatory impairment, abnormal ventilatory pattern, and ME/CFS are common in patients with PASC. The dysfunctional breathing, resting hypocapnia, and ME/CFS may contribute to symptoms. CPET is a valuable tool to assess these patients.

中文翻译：

对冠状病毒感染后不明原因呼吸困难患者进行心肺压力测试

目标

作者使用心肺运动测试 (CPET) 来定义严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 感染 (PASC) 急性后遗症患者的不明原因呼吸困难。我们评估了参与者的诊断肌痛性脑脊髓炎/慢性疲劳综合征 (ME/CFS) 的标准。

背景

大约 20% 从冠状病毒病 (COVID) 中康复的患者仍有症状。这种综合征被命名为 PASC。其病因尚不清楚。呼吸困难是一种常见的症状。

方法

作者在 COVID 后 8.9 ± 3.3 个月对 41 名 PASC 患者进行了 CPET 和 ME/CFS 症状评估。所有患者的肺功能检查、胸部 X 线检查和胸部计算机断层扫描均正常。测量了峰值耗氧量（峰值VO ₂）、每分钟通气量与CO ₂产生的斜率（VE/VCO ₂斜率）和CO ₂的潮气末压力（PetCO ₂）。通气模式被定义为快速不规则呼吸的功能失调性呼吸。

结果

研究了 18 名男性和 23 名女性（平均年龄：45 ± 13 岁）。左心室射血分数为 59% ± 9%。峰值 VO _{2平均为 20.3 ± 7 mL/kg/min（预测的 VO}₂为 77% ± 21% ）。VE/VCO ₂斜率为 30 ± 7。静止时的 PetCO ₂为 33.5 ± 4.5 mm Hg。24 名患者 (58.5%) 的峰值 VO ₂ <80% 的预测值。_{VO 2} <80%峰值的所有患者都存在运动循环受限。_{17 名 VO 2}峰值正常的患者中有 15名有通气异常，包括峰值呼吸频率 >55 (n = 3) 或呼吸功能障碍 (n = 12)。在整个队列中，88% 的患者 (n = 36) 出现通气异常并伴有呼吸功能障碍 (n = 26)、VE/VCO ₂升高(n = 17) 和/或低碳酸血症 PetCO ₂ <35 (n = 25) . 19 名患者 (46%) 符合 ME/CFS 标准。