Symptom persistence despite improvement in cardiopulmonary health -- Insights from longitudinal CMR, CPET and lung function testing post-COVID-19
<strong>Background</strong> The longitudinal trajectories of cardiopulmonary abnormalities and symptoms following infection with coronavirus disease (COVID-19) are unclear. We sought to describe their natural history in previously hospitalised patients, compare this with controls, and as...
| Үндсэн зохиолчид: | , , , , , , , , , , , , , , , |
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| Формат: | Journal article |
| Хэл сонгох: | English |
| Хэвлэсэн: |
Elsevier
2021
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| _version_ | 1826307537903812608 |
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| author | Cassar, MP Tunnicliffe, EM Petousi, N Lewandowski, AJ Xie, C Mahmod, M Samat, AHA Evans, RA Brightling, CE Ho, L-P Piechnik, SK Talbot, NP Holdsworth, D Ferreira, VM Neubauer, S Raman, B |
| author_facet | Cassar, MP Tunnicliffe, EM Petousi, N Lewandowski, AJ Xie, C Mahmod, M Samat, AHA Evans, RA Brightling, CE Ho, L-P Piechnik, SK Talbot, NP Holdsworth, D Ferreira, VM Neubauer, S Raman, B |
| author_sort | Cassar, MP |
| collection | OXFORD |
| description | <strong>Background</strong>
The longitudinal trajectories of cardiopulmonary abnormalities and symptoms following infection with coronavirus disease (COVID-19) are unclear. We sought to describe their natural history in previously hospitalised patients, compare this with controls, and assess the relationship between symptoms and cardiopulmonary impairment at 6 months post-COVID-19.
<br>
<strong>Methods</strong>
Fifty-eight patients and thirty matched controls (single visit), recruited between 14th March - 25th May 2020, underwent symptom-questionnaires, cardiac and lung magnetic resonance imaging (CMR), cardiopulmonary exercise test (CPET), and spirometry at 3 months following COVID-19. Of them, forty-six patients returned for follow-up assessments at 6 months.
• View related content for this article
<br>
<strong>Findings</strong>
At 2-3 months, 83% of patients had at least one cardiopulmonary symptom versus 33% of controls. Patients and controls had comparable biventricular volumes and function. Native cardiac T1 (marker of fibroinflammation) and late gadolinium enhancement (LGE, marker of focal fibrosis) were increased in patients at 2-3 months. Sixty percent of patients had lung parenchymal abnormalities on CMR and 55% had reduced peak oxygen consumption (pV̇O2) on CPET. By 6 months, 52% of patients remained symptomatic. On CMR, indexed right ventricular (RV) end-diastolic volume (-4·3 mls/m2, P=0·005) decreased and RV ejection fraction (+3·2%, P=0·0003) increased. Native T1 and LGE improved and was comparable to controls. Lung parenchymal abnormalities and peak V̇O2, although better, were abnormal in patients versus controls. 31% had reduced pV̇O2 secondary to symptomatic limitation and muscular impairment. Cardiopulmonary symptoms in patients did not associate with CMR, lung function, or CPET measures.
<br>
<strong>Interpretation</strong>
In patients, cardiopulmonary abnormalities improve over time, though some measures remain abnormal relative to controls. Persistent symptoms at 6 months post-COVID-19 did not associate with objective measures of cardiopulmonary health.
<br>
<strong>Funding</strong>
The authors’ work was supported by the NIHR Oxford Biomedical Research Centre, Oxford British Heart Foundation (BHF) Centre of Research Excellence (RE/18/3/34214), United Kingdom Research Innovation and Wellcome Trust. This project is part of a tier 3 study (C-MORE) within the collaborative research programme entitled PHOSP-COVID Post-hospitalization COVID-19 study: a national consortium to understand and improve long-term health outcomes, funded by the Medical Research Council and Department of Health and Social Care/National Institute for Health Research Grant (MR/V027859/1) ISRCTN number 10980107. |
| first_indexed | 2024-03-07T07:04:36Z |
| format | Journal article |
| id | oxford-uuid:511f355d-112c-475f-b74d-3314edb6c3d4 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T07:04:36Z |
| publishDate | 2021 |
| publisher | Elsevier |
| record_format | dspace |
| spelling | oxford-uuid:511f355d-112c-475f-b74d-3314edb6c3d42022-04-28T14:10:42ZSymptom persistence despite improvement in cardiopulmonary health -- Insights from longitudinal CMR, CPET and lung function testing post-COVID-19Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:511f355d-112c-475f-b74d-3314edb6c3d4EnglishSymplectic ElementsElsevier2021Cassar, MPTunnicliffe, EMPetousi, NLewandowski, AJXie, CMahmod, MSamat, AHAEvans, RABrightling, CEHo, L-PPiechnik, SKTalbot, NPHoldsworth, DFerreira, VMNeubauer, SRaman, B<strong>Background</strong> The longitudinal trajectories of cardiopulmonary abnormalities and symptoms following infection with coronavirus disease (COVID-19) are unclear. We sought to describe their natural history in previously hospitalised patients, compare this with controls, and assess the relationship between symptoms and cardiopulmonary impairment at 6 months post-COVID-19. <br> <strong>Methods</strong> Fifty-eight patients and thirty matched controls (single visit), recruited between 14th March - 25th May 2020, underwent symptom-questionnaires, cardiac and lung magnetic resonance imaging (CMR), cardiopulmonary exercise test (CPET), and spirometry at 3 months following COVID-19. Of them, forty-six patients returned for follow-up assessments at 6 months. • View related content for this article <br> <strong>Findings</strong> At 2-3 months, 83% of patients had at least one cardiopulmonary symptom versus 33% of controls. Patients and controls had comparable biventricular volumes and function. Native cardiac T1 (marker of fibroinflammation) and late gadolinium enhancement (LGE, marker of focal fibrosis) were increased in patients at 2-3 months. Sixty percent of patients had lung parenchymal abnormalities on CMR and 55% had reduced peak oxygen consumption (pV̇O2) on CPET. By 6 months, 52% of patients remained symptomatic. On CMR, indexed right ventricular (RV) end-diastolic volume (-4·3 mls/m2, P=0·005) decreased and RV ejection fraction (+3·2%, P=0·0003) increased. Native T1 and LGE improved and was comparable to controls. Lung parenchymal abnormalities and peak V̇O2, although better, were abnormal in patients versus controls. 31% had reduced pV̇O2 secondary to symptomatic limitation and muscular impairment. Cardiopulmonary symptoms in patients did not associate with CMR, lung function, or CPET measures. <br> <strong>Interpretation</strong> In patients, cardiopulmonary abnormalities improve over time, though some measures remain abnormal relative to controls. Persistent symptoms at 6 months post-COVID-19 did not associate with objective measures of cardiopulmonary health. <br> <strong>Funding</strong> The authors’ work was supported by the NIHR Oxford Biomedical Research Centre, Oxford British Heart Foundation (BHF) Centre of Research Excellence (RE/18/3/34214), United Kingdom Research Innovation and Wellcome Trust. This project is part of a tier 3 study (C-MORE) within the collaborative research programme entitled PHOSP-COVID Post-hospitalization COVID-19 study: a national consortium to understand and improve long-term health outcomes, funded by the Medical Research Council and Department of Health and Social Care/National Institute for Health Research Grant (MR/V027859/1) ISRCTN number 10980107. |
| spellingShingle | Cassar, MP Tunnicliffe, EM Petousi, N Lewandowski, AJ Xie, C Mahmod, M Samat, AHA Evans, RA Brightling, CE Ho, L-P Piechnik, SK Talbot, NP Holdsworth, D Ferreira, VM Neubauer, S Raman, B Symptom persistence despite improvement in cardiopulmonary health -- Insights from longitudinal CMR, CPET and lung function testing post-COVID-19 |
| title | Symptom persistence despite improvement in cardiopulmonary health -- Insights from longitudinal CMR, CPET and lung function testing post-COVID-19 |
| title_full | Symptom persistence despite improvement in cardiopulmonary health -- Insights from longitudinal CMR, CPET and lung function testing post-COVID-19 |
| title_fullStr | Symptom persistence despite improvement in cardiopulmonary health -- Insights from longitudinal CMR, CPET and lung function testing post-COVID-19 |
| title_full_unstemmed | Symptom persistence despite improvement in cardiopulmonary health -- Insights from longitudinal CMR, CPET and lung function testing post-COVID-19 |
| title_short | Symptom persistence despite improvement in cardiopulmonary health -- Insights from longitudinal CMR, CPET and lung function testing post-COVID-19 |
| title_sort | symptom persistence despite improvement in cardiopulmonary health insights from longitudinal cmr cpet and lung function testing post covid 19 |
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