Cardiopulmonary exercise testing excludes significant disease in patients recovering from COVID-19

Holdsworth DA, Barker-Davies RM, Chamley RR, O'Sullivan O, Ladlow P, May S, Houston AD, Mulae J, Xie C, Cranley M, Sellon E, Naylor J, Halle M, Parati G, Davos C, Rider OJ, Bennett AB, Nicol ED (2022)

Publication Type: Journal article

Publication year: 2022

Journal

BMJ Military Health BMJ Publishing Group

Article Number: e002193

DOI: 10.1136/military-2022-002193

Abstract

Objective: Post-COVID-19 syndrome presents a health and economic challenge affecting ∼10% of patients recovering from COVID-19. Accurate assessment of patients with post-COVID-19 syndrome is complicated by health anxiety and coincident symptomatic autonomic dysfunction. We sought to determine whether either symptoms or objective cardiopulmonary exercise testing could predict clinically significant findings. Methods: 113 consecutive military patients were assessed in a comprehensive clinical pathway. This included symptom reporting, history, examination, spirometry, echocardiography and cardiopulmonary exercise testing (CPET) in all, with chest CT, dual-energy CT pulmonary angiography and cardiac MRI where indicated. Symptoms, CPET findings and presence/absence of significant pathology were reviewed. Data were analysed to identify diagnostic strategies that may be used to exclude significant disease. Results: 7/113 (6%) patients had clinically significant disease adjudicated by cardiothoracic multidisciplinary team (MDT). These patients had reduced fitness (V˙O2 26.7 (±5.1) vs 34.6 (±7.0) mL/kg/min; p=0.002) and functional capacity (peak power 200 (±36) vs 247 (±55) W; p=0.026) compared with those without significant disease. Simple CPET criteria (oxygen uptake (V˙O2) >100% predicted and minute ventilation (VE)/carbon dioxide elimination (V˙CO2) slope <30.0 or VE/V˙CO2 slope <35.0 in isolation) excluded significant disease with sensitivity and specificity of 86% and 83%, respectively (area under the receiver operating characteristic curve (AUC) 0.89). The addition of capillary blood gases to estimate alveolar-arterial gradient improved diagnostic performance to 100% sensitivity and 78% specificity (AUC 0.92). Symptoms and spirometry did not discriminate significant disease. Conclusions: In a population recovering from SARS-CoV-2, there is reassuringly little organ pathology. CPET and functional capacity testing, but not reported symptoms, permit the exclusion of clinically significant disease.

Involved external institutions

Technische Universität München (TUM) DE Germany (DE) King’s College London GB United Kingdom (GB) Academy of Athens / Ακαδημία Αθηνών GR Greece (GR) Oxford University Hospitals NHS Foundation Trust GB United Kingdom (GB) University of Milano-Bicocca / Università degli Studi di Milano-Bicocca, UNIMIB IT Italy (IT) Queen Elizabeth Hospital Birmingham GB United Kingdom (GB) Defence Medical Services (DMS) GB United Kingdom (GB)

How to cite

APA:

Holdsworth, D.A., Barker-Davies, R.M., Chamley, R.R., O'Sullivan, O., Ladlow, P., May, S.,... Nicol, E.D. (2022). Cardiopulmonary exercise testing excludes significant disease in patients recovering from COVID-19. BMJ Military Health. https://dx.doi.org/10.1136/military-2022-002193

MLA:

Holdsworth, D. A., et al. "Cardiopulmonary exercise testing excludes significant disease in patients recovering from COVID-19." BMJ Military Health (2022).

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