Importance of Cardiopulmonary Exercise Testing amongst Subjects Recovering from COVID-19

Gianluigi Dorelli, Michele Braggio, Daniele Gabbiani, Fabiana Busti, Marco Caminati, Gianenrico Senna, Domenico Girelli, Pierantonio Laveneziana, Marcello Ferrari, Giulia Sartori, Luca Dalle Carbonare, Ernesto Crisafulli, On Behalf Of The Respicovid Study Investigators, Gianluigi Dorelli, Michele Braggio, Daniele Gabbiani, Fabiana Busti, Marco Caminati, Gianenrico Senna, Domenico Girelli, Pierantonio Laveneziana, Marcello Ferrari, Giulia Sartori, Luca Dalle Carbonare, Ernesto Crisafulli, On Behalf Of The Respicovid Study Investigators

Abstract

The cardiopulmonary exercise test (CPET) provides an objective assessment of ventilatory limitation, related to the exercise minute ventilation (VE) coupled to carbon dioxide output (VCO2) (VE/VCO2); high values of VE/VCO2 slope define an exercise ventilatory inefficiency (EVin). In subjects recovered from hospitalised COVID-19, we explored the methodology of CPET in order to evaluate the presence of cardiopulmonary alterations. Our prospective study (RESPICOVID) has been proposed to evaluate pulmonary damage's clinical impact in post-COVID subjects. In a subgroup of subjects (RESPICOVID2) without baseline confounders, we performed the CPET. According to the VE/VCO2 slope, subjects were divided into having EVin and exercise ventilatory efficiency (EVef). Data concerning general variables, hospitalisation, lung function, and gas-analysis were also collected. The RESPICOVID2 enrolled 28 subjects, of whom 8 (29%) had EVin. As compared to subjects with EVef, subjects with EVin showed a reduction in heart rate (HR) recovery. VE/VCO2 slope was inversely correlated with HR recovery; this correlation was confirmed in a subgroup of older, non-smoking male subjects, regardless of the presence of arterial hypertension. More than one-fourth of subjects recovered from hospitalised COVID-19 have EVin. The relationship between EVin and HR recovery may represent a novel hallmark of post-COVID cardiopulmonary alterations.

Keywords: COVID-19; cardiopulmonary exercise test; cardiovascular alterations; exercise ventilatory inefficiency; heart rate recovery.

Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Scatterplot between VE/VCO2 slope and HR recovery. Lines represent the regression with the 95% confidence intervals. Abbreviations: VE/VCO2 slope represents the slope of minute ventilation-VE to carbon dioxide output-VCO2 ratio; HR, heart rate.
Figure 2
Figure 2
Receiver operating curve of HR recovery, performed on subjects with ventilatory inefficiency as test variable. Gray line represents a diagonal of reference.

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Source: PubMed

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