Kersten Johannes, Baumhardt Michael, Hartveg Paul, Hoyo Luis, Hüll Elina, Imhof Armin, Kropf-Sanchen Cornelia, Nita Nicoleta, Mörike Johannes, Rattka Manuel, Andreß Stefanie, Scharnbeck Dominik, Schmidtke-Schrezenmeier Gerlinde, Tadic Marijana, Wolf Alexander, Rottbauer Wolfgang, Buckert Dominik
Department for Internal Medicine II, University of Ulm, 89081 Ulm, Germany.
J Clin Med. 2021 Aug 24;10(17):3782. doi: 10.3390/jcm10173782.
(1) Background: Long COVID syndrome refers to long-term sequelae of the novel viral disease, which occur even in patients with initially mild disease courses. However, there is still little evidence of the actual organic consequences and their frequency, and there is no standardized workup to diagnose long COVID syndrome yet. In this study, we aim to determine the efficiency of a stepwise diagnostic approach for reconvalescent COVID-19 patients with cardiopulmonary symptoms. (2) Methods: The diagnostic workup for long COVID syndrome included three steps. In the first step, the focus was on broad applicability (e.g., blood tests and body plethysmography). In the second step, cardiopulmonary exercise testing (CPET) and cardiac MRI (CMR) were used. The third step was tailored to the individual needs of each patient. The observation period lasted from 22 February to 14 May 2021. (3) Results: We examined 231 patients in our long COVID unit (mean [SD] age, 47.8 [14.9], 132 [57.1%] women). Acute illness occurred a mean (SD) of 121 (77) days previously. Suspicious findings in the first visit were seen in 80 (34.6%) patients, prompting further diagnostics. Thirty-six patients were further examined with CPET and CMR. Of those, 16 (44.4%) had pathological findings. The rest had functional complaints without organ damage ("functional long COVID"). Cardiopulmonary sequelae were found in asymptomatic as well as severe courses of the initial COVID-19 disease. (4) Conclusions: A structured diagnostic pathway for the diagnosis of long COVID syndrome is practicable and rational in terms of resource allocation. With this approach, manifest organ damage can be accurately and comprehensively diagnosed and distinguished from functional complaints.
(1) 背景：新冠后综合征指的是这种新型病毒性疾病的长期后遗症，即便在疾病初发时病情较轻的患者中也会出现。然而，关于实际的器质性后果及其发生率仍证据不足，且目前尚无用于诊断新冠后综合征的标准化检查方法。在本研究中，我们旨在确定一种逐步诊断方法对有心肺症状的新冠康复患者的有效性。(2) 方法：对新冠后综合征的诊断检查包括三个步骤。第一步重点在于广泛适用性（如血液检查和体容积描记法）。第二步使用心肺运动试验（CPET）和心脏磁共振成像（CMR）。第三步则根据每位患者的个体需求进行定制。观察期从2021年2月22日持续至5月14日。(3) 结果：我们在新冠后病房检查了231例患者（平均[标准差]年龄为47.8[14.9]岁，132例[57.1%]为女性）。急性疾病发生时间平均（标准差）为121（77）天前。首次就诊时有可疑发现的患者有80例（34.6%），需进一步诊断。36例患者接受了CPET和CMR进一步检查。其中16例（44.4%）有病理结果。其余患者有功能性主诉但无器官损伤（“功能性新冠后综合征”）。在初始新冠疾病的无症状及重症病程中均发现了心肺后遗症。(4) 结论：对于新冠后综合征的诊断，一种结构化的诊断途径在资源分配方面是可行且合理的。通过这种方法，可以准确、全面地诊断明显的器官损伤，并将其与功能性主诉区分开来。
