Aparisi Álvaro, Ybarra-Falcón Cristina, García-Gómez Mario, Tobar Javier, Iglesias-Echeverría Carolina, Jaurrieta-Largo Sofía, Ladrón Raquel, Uribarri Aitor, Catalá Pablo, Hinojosa Williams, Marcos-Mangas Marta, Fernández-Prieto Laura, Sedano-Gutiérrez Rosa, Cusacovich Iván, Andaluz-Ojeda David, de Vega-Sánchez Blanca, Recio-Platero Amada, Sanz-Patiño Esther, Calvo Dolores, Baladrón Carlos, Carrasco-Moraleja Manuel, Disdier-Vicente Carlos, Amat-Santos Ignacio J, San Román J Alberto
Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain.
Departamento de Neumología, Hospital Clínico Universitario de Valladolid, 47005 Valladolid, Spain.
J Clin Med. 2021 Jun 11;10(12):2591. doi: 10.3390/jcm10122591.
Coronavirus disease 2019 (COVID-19) is a systemic disease characterized by a disproportionate inflammatory response in the acute phase. This study sought to identify clinical sequelae and their potential mechanism.
We conducted a prospective single-center study (NCT04689490) of previously hospitalized COVID-19 patients with and without dyspnea during mid-term follow-up. An outpatient group was also evaluated. They underwent serial testing with a cardiopulmonary exercise test (CPET), transthoracic echocardiogram, pulmonary lung test, six-minute walking test, serum biomarker analysis, and quality of life questionaries.
Patients with dyspnea (n = 41, 58.6%), compared with asymptomatic patients (n = 29, 41.4%), had a higher proportion of females (73.2 vs. 51.7%; = 0.065) with comparable age and prevalence of cardiovascular risk factors. There were no significant differences in the transthoracic echocardiogram and pulmonary function test. Patients who complained of persistent dyspnea had a significant decline in predicted peak VO consumption (77.8 (64-92.5) vs. 99 (88-105); < 0.00; < 0.001), total distance in the six-minute walking test (535 (467-600) vs. 611 (550-650) meters; = 0.001), and quality of life (KCCQ-23 60.1 ± 18.6 vs. 82.8 ± 11.3; < 0.001). Additionally, abnormalities in CPET were suggestive of an impaired ventilatory efficiency (VE/VC slope 32 (28.1-37.4) vs. 29.4 (26.9-31.4); = 0.022) and high PET (34.5 (32-39) vs. 38 (36-40); = 0.025).
In this study, >50% of COVID-19 survivors present a symptomatic functional impairment irrespective of age or prior hospitalization. Our findings suggest a potential ventilation/perfusion mismatch or hyperventilation syndrome.
2019冠状病毒病（COVID-19）是一种全身性疾病，其特征是在急性期出现不成比例的炎症反应。本研究旨在确定临床后遗症及其潜在机制。
我们对之前住院的COVID-19患者进行了一项前瞻性单中心研究（NCT04689490），这些患者在中期随访期间有或没有呼吸困难。还对一个门诊组进行了评估。他们接受了一系列测试，包括心肺运动试验（CPET）、经胸超声心动图、肺功能测试、六分钟步行试验、血清生物标志物分析和生活质量问卷。
与无症状患者（n = 29，41.4%）相比，有呼吸困难的患者（n = 41，58.6%）中女性比例更高（73.2%对51.7%；P = 0.065），年龄和心血管危险因素患病率相当。经胸超声心动图和肺功能测试无显著差异。主诉持续呼吸困难的患者预测的峰值摄氧量显著下降（77.8（64 - 92.5）对99（88 - 105）；P < 0.00；d < 0.001），六分钟步行试验中的总距离（535（467 - 600）对611（550 - 650）米；P = 0.001），以及生活质量（堪萨斯城心肌病问卷-23 60.1 ± 18.6对82.8 ± 11.3；P < 0.001）。此外，CPET异常提示通气效率受损（VE/VC斜率32（28.1 - 37.4）对29.4（26.9 - 31.4）；P = 0.022）和高PET（34.5（32 - 39）对38（36 - 40）；P = 0.025）。
在本研究中，超过50%的COVID-19幸存者存在有症状的功能损害，无论年龄或既往住院情况如何。我们的研究结果提示存在潜在的通气/灌注不匹配或过度通气综合征。
