Exercise performance in patients with post-acute sequelae of SARS-CoV-2 infection compared to patients with unexplained dyspnea, 2021, Alba et al

Abstract

Background
Dyspnea and exercise intolerance are commonly reported post-acute sequelae of SARS-CoV-2 infection (PASC), but routine diagnostic testing is often normal. Cardiopulmonary exercise testing (CPET) offers comprehensive assessment of dyspnea to characterize pulmonary PASC.

Methods
We performed a retrospective cohort study of CPET performed on patients reporting dyspnea and/or exercise intolerance following confirmed Covid-19 between August 1, 2020 and March 1, 2021, and compared them to age- and sex-matched patients with unexplained dyspnea referred for CPET at the same center in the pre-Covid-19 era.

Findings
Compared to matched unexplained dyspnea comparators, PASC patients shared similar medical comorbidities and subjective dyspnea at referral (mMRC score 1.6 ± 0.9 vs. 1.4 ± 0.9, P = 0.5). Fifteen (83.3%) PASC patients underwent high resolution computed tomography of the chest, of which half (46.7%) were normal, and 17 (94.4%) patients had pulmonary function testing, of which the majority (76.5%) were normal. All patients underwent CPET, and 12 (67%) had normal findings. Compared to matched comparators, PASC patients had similar peak oxygen consumption, oxygen consumption at ventilatory anaerobic threshold, and ventilatory efficiency measured by the minute ventilation to carbon dioxide production (VE/VCO2) slope.

Interpretation
Despite prominent dyspnea, physiological abnormalities on CPET were mild across a range of initial Covid-19 severity and similar to matched comparators referred for dyspnea without antecedent SARS-CoV-2.

Open access, https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00346-1/fulltext#

 

Which suggests that most symptoms in these patients is not explained by pulmonary dysfunction.

 

If only they had done 2 consecutive tests.

 

@Mithriel just noticed your profile picture and that bear looks like it was introduced to a not very friendly porcupine!

 

My son made a photographic image of my life for a college course. A pictorial image of life with ME, stuck inside, in constant pain.

 

I wondered too about your teddy bear, @Mithriel

It's clear now. And, an excellent way to present ME, I think. The juxtaposition of a very familiar, well-loved, symbol of softness, warmth, happiness, care, and safety, contrasted with the unknown, unfamiliar, cruel, devastating, mistreated community with this horrible disease. And, behind bars!

I think this could be a traveling art exhibit.

Thank you to you and your son, for this impactful image!