Severe COVID-19 and its cardiopulmonary effects 6 and 18 months after hospital discharge

Introduction

SARS-CoV-2 infection affects the cardiopulmonary system in the acute as well as long-term phase. The aim of the present study was to comprehensively assess symptoms and possible long-term impairments 6 and 18 months after hospitalization for severe COVID-19 infection.

Methods

This prospective registry included patients with PCR-confirmed COVID-19 infection requiring hospitalization. Follow-up approximately 6 months post discharge comprised a detailed patient history, clinical examination, transthoracic echocardiography, electrocardiogram, cardiac magnetic resonance imaging (cMRI), chest computed tomography (CT) scan, pulmonary function test (PFT), six-minute walk test (6MWT) and a laboratory panel. At the time of the second follow-up visit at 18 months, patients without pathologic findings during the first study visit were contacted by phone to inquire about the course of their symptoms. In all other patients all initial examinations were repeated.

Results

Two hundred Patients, who were hospitalized for COVID-19, were contacted by phone and were recruited for the study. Due to dropouts the second study visit was performed in 170 patients. A comparison between the two study visits at 6 and 18 months post discharge showed the following results: Six months after discharge, 73% and 18 months after discharge 52% fulfilled the criteria for Long COVID with fatigue being the most common symptom (49%). Echocardiography at 6 months post discharge showed an impaired left ventricular function in 8% of which 80% returned to normal. Six months post discharge, cMRI revealed pericardial effusion in 17% which resolved in 47% of the 15 patients who underwent a control cMRI. Signs of peri- or myocarditis were present in 5% of the patients and were resolved in all 4 patients who attended control studies. At 6 months, chest CT scans identified post-infectious residues in 24%. In the 25 repeated chest CT scans 20% showed full recovery. Length of in-hospital stay was identified as a significant predictor for persisting Long COVID (95% CI: 1.005-1.12, p = 0.03).

Conclusion

Comparing 6 to 18 months, the prevalence of Long COVID decreased over time, but a high symptom burden remained. Structural and functional abnormalities were less frequent than the portrayed symptoms, and it thus remains a challenge to substantiate the symptoms.

Cardiopulmonary long-term effects in patients after hospitalization due to COVID-19 infection

Background

Multiple studies have described acute effects of the Covid-19 infection on the heart, but little is known about the long-term cardiac and pulmonary effects and complications after recovery. The aim of this analysis was to deliver a comprehensive report of symptoms and possible long-term impairments after hospitalization because of Covid-19 infection as well as to try to identify predictors for Long-Covid.

Methods

This was a prospective, multicenter registry study. Patients with verified Covid-19 infection, who were treated as in-patients at our dedicated Covid hospital (Clinic Favoriten), have been included in this study. In all patients, testing was performed approximately 6 months post discharge. During the study visit the following tests and investigations were performed: detailed patient history and clinical examination, transthoracic echocardiography, electrocardiography, cardiac magnetic resonance imaging (MRI), chest computed tomography (CT) scan, lung function test and a comprehensive list of laboratory parameters including cardiac bio markers.

Results

Between July 2020 and October 2021, 150 patients were recruited. Sixty patients (40%) were female and the average age was 53.5±14.5 years. Of all patients, 92% had been admitted to our general ward and 8% had a severe course of disease, requiring admission to our intensive care unit. Six months after discharge the majority of patients still experienced symptoms and 75% fulfilled the criteria for Long-Covid. Only 24% were completely asymptomatic (figure 1).

Echocardiography detected reduced global longitudinal strain (GLS) in 11%. Cardiac MRI revealed pericardial effusion in 18%. Furthermore, cardiac MRI showed signs of former peri- or myocarditis in 4%. Pulmonary CT scans identified post-infectious residues, such as bilateral ground glass opacities and fibrosis in 22%. Exertional dyspnea was associated with either reduced forced vital capacity measured during pulmonary function tests in 11%, with reduced GLS and/or diastolic dysfunction, thus providing evidence for a cardiac and/or pulmonary cause.

Independent predictors for Long-Covid were markers of a more severe disease course like length of in-hospital stay, admission to an intensive care unit, type of ventilation as well as higher NT-proBNP and/or troponin levels.

Conclusion

Even 6 months after recovery from Covid-19 infection, the majority of previously hospitalized patients still suffer from at least one symptom, such as chronic fatigue and/or exertional dyspnea. While there was no association between fatigue and cardiopulmonary abnormalities, impaired lung function, reduced GLS and/or diastolic dysfunction were significantly more prevalent in patients presenting with exertional dyspnea. On chest CT approximately one fifth of all patients showed post infectious changes in chest CT including evidence for myo- and pericarditis as well as accumulation of pericardial effusions.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Major fund

Are there any long-term cardio-pulmonary limitations of hospitalized Covid-19 patients?

Background

The Covid-19 pandemic has affected our lives for over a year and almost 500.000 people in Austria have been infected. Although many of them only had low or mild symptoms some had to be treated in the hospital. Even months after their infection some patients complain about fatigue, exercise intolerance and dyspnoea.

The aim of this study was to perform a follow-up cardiopulmonary exercise test (CPET) on those patients, at 6 months after their hospitalization to find out if there are long-term cardio-pulmonary limitations (CPL) of Covid-19.

We also wanted to check if there is any difference in outcome and CPL between patients who received oxygen therapy vs. without oxygen therapy.

Methods

40 patients were included into this study (16 women = 40%; 24 men = 60%). All patients were hospitalized during their infection with Covid-19 (5 patients at ICU) and underwent CPET 6±2 month after discharge. 20 patients (50%) received oxygen therapy or ventilation during their hospitalization.

CPET data were assessed at rest, during exercise and at recovery. Blood parameters including NT-pro BNP were collected and an interview and examination were performed.

CPL was defined as VO2% of Predicted ≤84%, VE/CO2 Slope ≥34 and RER at peak of exercise ≥1.1.

Results

Median age of all patients was 46 years [interquartile range (IQR): 35.3–55.8], median BMI was 26.0 m2/kg [IQR: 23.0–29.0] and the median NTproBNP was 53.1 pg/mL [IQR: 24.0–95.6].

When comparing the two groups, we found higher percentage of CPL in patients who received oxygen therapy during their hospitalization (10% with oxygen vs. 5% without oxygen). Notably, the number of patients with a BMI ≥25 m2/kg was higher in the oxygen therapy group than in those without oxygen (80% vs. 45%). The median BMI without oxygen therapy was 24.0 [IQR: 20.3–26.8] vs. 29.0 [IQR: 25.0–31.0] with oxygen therapy (p=0.004). There were no significant differences in NT-proBNP levels (p=0.545).

The median VO2% of predicted was 88.0% [72.5–98.0] without oxygen therapy vs. 84.5% [IQR: 70.8–91.8] with oxygen therapy (p=0.289), the median HR percentage of predicted was 92.5% [IQR: 85.5–97.8] without oxygen therapy vs. 94.5% [IQR: 88.3–103.5] with oxygen therapy (p=0.478), the median physical performance in watt in patients without oxygen therapy was 130.0 [IQR: 108.5–197.5] vs. 135.0 [IQR: 97.0–188.3] with oxygen therapy (p=0.820).

Conclusion

The findings of our study did not show any statistically significant difference in long-term CPL between patients who received oxygen therapy vs. those who didn't.

Therefore, other causes of the exercise intolerance and dyspnoea have to be discussed multidisciplinary.

Subclinical CPL in the absence of significant clinical symptoms represent a concern after a Covid-19 infection. Overall, 7.5% of our patients showed CPL although those patients didn't have any clinical symptoms. Therefore, CPET is a good method to discover asymptomatic patients with CPL.

Funding Acknowledgement

Type of funding sources: None.

Long-term cardiopulmonary effects after Covid-19 infection

Introduction

The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic of 2020 has an influence on people's lives worldwide, impacting global health and putting pressure on health care systems. Multiple studies have described acute effects of the Covid-19 infection on the heart, but little is known about the long-term cardiac effects and complications after recovery. The aim of this analysis was to deliver a comprehensive report of symptoms and long-term impairment after Covid-19 infection.

Methods

This study was a prospective, multicenter registry study. Patients with verified COVID-19 infection, who were treated at our dedicated COVID hospital (Klinik Favoriten), have been included in this study. In all patients, testing was performed approximately 6 months post discharge. During each study visit the following tests and investigations were performed: detailed patient history and clinical examination, transthoracic echocardiography, electrocardiography, cardiac magnetic resonance imaging (MRI), pulmonary computed tomography (CT) scan, lung function test, spiroergometry and six-minute walk test (6MWT), and a comprehensive list of laboratory parameters including cardiac bio markers such as brain natriuretic peptide (NTpro BNP) and troponin T.

Results

In this interim analysis of an ongoing trial, the first 65 patients are presented. Baseline values are shown in table 1: 34 (59%) were male and the median age was 48.5 years (36.4–59.3). 86% of all patients included so far had an only mild to moderate course of disease and 14% of them had a severe course and were admitted to our intensive care unit. At the time of the study visit, the majority of patients still complained about symptoms: 40% presented with fatigue and weakness, 36% with exertional dyspnea, 21% with vertigo, 17% had an impaired taste or smell. Only 28% were completely asymptomatic (figure 1). From a cardiac perspective, the only abnormal findings noted in echocardiography studies were reduced left ventricular global longitudinal strain. Cardiac MRI revealed pericardial effusion in 19%, however, these were only minimal (≤9mm) and not visible in echocardiography. Furthermore, cardiac MRI showed positive late gadolinium enhancement in 11%. Pulmonary function tests were abnormal in 16%. Pulmonary CT scans showed post infectious residues like bilateral ground glass opacities and fibrosis in 45%. Exercise capacity as measured by the 6-minute walk test with BORG Dyspnea Score and by spiroergometry was reduced in almost 40% of our study participants.

Conclusions

This interim analysis showed that most previously hospitalized patients still suffer from chronic fatigue, exertional dyspnea and impaired cardiopulmonary function after Covid-19 infection. Furthermore, even though cardiac and pulmonary imaging revealed numerous pathologic findings, and exercise capacity was reduced, no correlations could be found with persisting symptoms.

Funding Acknowledgement

Type of funding sources: Public hospital(s). Main funding source(s): Klink Favoriten and Medical University hospital Vienna