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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. Cardiopulmonary exercise testing excludes significant disease in patients recovering from COVID-19. BMJ Mil Health 2022:military-2022-002193. [PMID: 36442889 DOI: 10.1136/military-2022-002193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/19/2022] [Indexed: 11/29/2022]
Abstract
ObjectivePost-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.Methods113 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.Results7/113 (6%) patients had clinically significant disease adjudicated by cardiothoracic multidisciplinary team (MDT). These patients had reduced fitness (V̇O226.7 (±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 (V̇O2) >100% predicted and minute ventilation (VE)/carbon dioxide elimination (V̇CO2) slope <30.0 or VE/V̇CO2slope <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.ConclusionsIn 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.
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Affiliation(s)
- D A Holdsworth
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Royal Centre for Defence Medicine, Birmingham, UK
| | - R M Barker-Davies
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - R R Chamley
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Centre for Clincal Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - O O'Sullivan
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - P Ladlow
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
| | - S May
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - A D Houston
- Academic Department of Military Rehabilitation, Defence Medical Services, Loughborough, UK
| | - J Mulae
- Royal Centre for Defence Medicine, Birmingham, UK
| | - C Xie
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - M Cranley
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - E Sellon
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Royal Centre for Defence Medicine, Birmingham, UK
| | - J Naylor
- Royal Centre for Defence Medicine, Birmingham, UK
| | - M Halle
- Klinikum rechts der Isar der Technischen Universität München, Munchen, Germany
| | - G Parati
- Università degli Studi di Milano-Bicocca, Milano, Italy
| | - C Davos
- Academy of Athens Biomedical Research Foundation, Athens, Greece
| | - O J Rider
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Oxford Centre for Clincal Magnetic Resonance Research, University of Oxford, Oxford, UK
| | - A B Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Loughborough, UK
- Defence Medical Rehabilitation Centre Stanford Hall, Loughborough, UK
| | - E D Nicol
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
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