Trial Report Cardiopulmonary Exercise Testing in Children With Long COVID: A Case-controlled Study, 2024, Baldi

[Dolphin]

Free full text:
https://journals.lww.com/pidj/fullt...ry_exercise_testing_in_children_with.849.aspx

COVID REPORTS
Cardiopulmonary Exercise Testing in Children With Long COVID: A Case-controlled Study

Baldi, Fabiana MD*; De Rose, Cristina MD†; Mariani, Francesco MD†; Morello, Rosa MD†; Raffaelli, Francesca MD‡; Valentini, Piero MD†; Buonsenso, Danilo MD†,§

Author Information
The Pediatric Infectious Disease Journal ():10.1097/INF.0000000000004371, May 07, 2024. | DOI: 10.1097/INF.0000000000004371

• OPEN
• PAP

Abstract
Background:
Cardiopulmonary exercise testing (CPET) is a noninvasive and nonexpensive diagnostic tool, that provides a comprehensive evaluation of the pulmonary, cardiovascular, and skeletal muscle systems’ integrated reactions to exercise. CPET has been extensively used in adults with Long COVID (LC), while the evidence about its role in children with this condition is scarce.

Methods:
Prospective, case-controlled observational study. Children with LC and a control group of healthy children underwent CPET. CPET findings were compared within the 2 groups, and within the LC groups according to main clusters of persisting symptoms.

Results:
Sixty-one children with LC and 29 healthy controls were included. Overall, 90.2% of LC patients (55 of 61) had a pathologic test vs 10.3% (3/29) of the healthy control. Children with LC presented a statistically significant higher probability of having abnormal values of peak VO2 (P = 0.001), AT% pred (P <0.001), VO2/HR % (P = 0.03), VO2 work slope (P = 0.002), VE/VCO2 slope (P = 0.01). The mean VO2 peak was 30.17 (±6.85) in LC and 34.37 (±6.55) in healthy patients (P = 0.007).

Conclusions:
Compared with healthy controls, children with LC have objective impaired functional capacity (expressed by a low VO2 peak), signs of deconditioning and cardiogenic inefficiency when assessed with CPET. As such, CPET should be routinely used in clinical practice to objectify and phenotype the functional limitations of children with LC, and to follow-up them.

 

[alex3619]

... and the repeat test?

 

[Lou B Lou]

'Compared with healthy controls, children with LC have objective impaired functional capacity (expressed by a low VO2 peak), signs of deconditioning and cardiogenic inefficiency when assessed with CPET. As such, CPET should be routinely used in clinical practice to objectify and phenotype the functional limitations of children with LC, and to follow-up them.'


Reads like they're set to use CPET as a weapon.

.

 

[SNT Gatchaman]

... and the repeat test?

Last, many studies have demonstrated that a 2-day CPET study can be even more useful to document postexertional malaise in LC and myalgic encephalomyelitis/chronic fatigue syndrome patients, however, our resources did not allow that.

 

[SNT Gatchaman]

Some quotes from the discussion —

To our knowledge, this is the largest case-controlled study documenting that children with LC have objective pathological findings at CPET compared with controls. Children with LC have a reduced VO2 peak (Oxygen uptake at peak of exercise), abnormal cardiovascular efficiency (VO2/HR% pred), pathological VE/VCO slope (indicative of the possible presence of ventilatory inefficiency/pulmonary vascular commitment if higher than 30), and abnormally reduced slope of VO2 work (indicative of muscle deconditioning). In addition, we stratified the probability that an altered VE/VCO2 slope was indicative of an underlying pulmonary vasculopathy such as pulmonary hypertension by combining the parameters of VE/VCO2 (AT) and PETCO2 (AT) measured at anaerobic threshold value, and it emerged that 48% of the LC patients had a suspicious phenotype for pulmonary hypertension. Conversely, heart rate analyses and parameters of respiratory function [expressed by a normal breathing reserve (BR) and absence of desaturation of SpO2 at peak of exercise] were similarly normal in cases and controls.

Altogether, our study opens a new scenario in terms of diagnostic possibilities for children with suspected LC, but also a new hypothesis in terms of mechanisms leading to common symptoms in LC, like fatigue and exercise intolerance, suggesting that pediatric LC is a real disease and not a psychologic consequence of the pandemic.

distinguishing deconditioning from altered oxygen delivery, mitochondrial dysfunction and muscular pathology, can be challenging with noninvasive CPET (invasive CPET is difficult to be done in children) without adjunctive testing or without having preCOVID-19 CPET for comparison.

In addition to muscular decondition, our study found that a subgroup of patients has CPET documentation of cardiovascular limitation leading to exercise intolerance (many children, in fact, were not able to conclude the test). These events during LC are more probably due to poorly characterized functional events, like autonomic dysfunction or other unknown factors, rather than macroscopic heart damage.

Some CPET studies reported chronotropic incompetence, while others observed an abnormal HR recovery. In our study HR was normal, while chronotropic incompetence was sometimes found. Autonomic dysfunction and endothelial dysfunction are possible mechanisms for these findings [...]. Dysfunctional breathing may also be a manifestation of dysautonomia. The autonomic nervous system and endothelial interaction may regulate peripheral vasomotor tone; together, they may explain differences in peripheral extraction and preload failure.

In our cohort, some children had CPET findings indicative of pulmonary hypertension. [...] in the presence of typical findings in results of CPET (such as reduced VO2 peak, an high VE/VCO2 slope and low PET CO2 at anaerobic threshold) we can reasonably differentiate a pulmonary vascular limitation to exercise and aid diagnosis in patients with exertional dyspnea, especially in patients with a high-risk population, providing an earlier detection in patients more likely to have pulmonary hypertension before resting adaptation become apparent (this could explain the normal results seen in our echocardiograms).

 

[rvallee]

Altogether, our study opens a new scenario in terms of diagnostic possibilities for children with suspected LC, but also a new hypothesis in terms of mechanisms leading to common symptoms in LC, like fatigue and exercise intolerance, suggesting that pediatric LC is a real disease and not a psychologic consequence of the pandemic.

Again with this. There is zero evidence that it has anything to do with psychological consequences, but the way it's framed it has to be falsified in order not to be considered true. This is not how science works! Cultural beliefs are not a basis of evidence for anything anymore than swords in ponds are a proper basis to determine who should be in charge!

Even if they consider it mostly disputed, they still give weight to the lie by agreeing that unless they see evidence of something else, then it's not just a valid possibility, but a fact.

 

[SNT Gatchaman]

But, but... there are thousands of papers saying that this is the thing and obviously it's just common sense - I mean just ask the person-in-the-street about those lockdowns, amirite?

I don't know, but charitably if you're publishing findings and hypotheses that go against the tide (alt. the contents of Augeas' stables) maybe it's Realacademik?