Cassar Mark Philip, Tunnicliffe Elizabeth M, Petousi Nayia, Lewandowski Adam J, Xie Cheng, Mahmod Masliza, Samat Azlan Helmy Abd, Evans Rachael A, Brightling Christopher E, Ho Ling-Pei, Piechnik Stefan K, Talbot Nick P, Holdsworth David, Ferreira Vanessa M, Neubauer Stefan, Raman Betty
Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom.
Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom.
EClinicalMedicine. 2021 Nov;41:101159. doi: 10.1016/j.eclinm.2021.101159. Epub 2021 Oct 20.
The longitudinal trajectories of cardiopulmonary abnormalities and symptoms following infection with coronavirus disease (COVID-19) are unclear. We sought to describe their natural history in previously hospitalised patients, compare this with controls, and assess the relationship between symptoms and cardiopulmonary impairment at 6 months post-COVID-19.
Fifty-eight patients and thirty matched controls (single visit), recruited between 14 March - 25 May 2020, underwent symptom-questionnaires, cardiac and lung magnetic resonance imaging (CMR), cardiopulmonary exercise test (CPET), and spirometry at 3 months following COVID-19. Of them, forty-six patients returned for follow-up assessments at 6 months.
At 2-3 months, 83% of patients had at least one cardiopulmonary symptom versus 33% of controls. Patients and controls had comparable biventricular volumes and function. Native cardiac T (marker of fibroinflammation) and late gadolinium enhancement (LGE, marker of focal fibrosis) were increased in patients at 2-3 months. Sixty percent of patients had lung parenchymal abnormalities on CMR and 55% had reduced peak oxygen consumption (pV̇O) on CPET. By 6 months, 52% of patients remained symptomatic. On CMR, indexed right ventricular (RV) end-diastolic volume (-4·3 mls/m, =0·005) decreased and RV ejection fraction (+3·2%, =0·0003) increased. Native T and LGE improved and was comparable to controls. Lung parenchymal abnormalities and peak V̇O, although better, were abnormal in patients versus controls. 31% had reduced pV̇O secondary to symptomatic limitation and muscular impairment. Cardiopulmonary symptoms in patients did not associate with CMR, lung function, or CPET measures.
In patients, cardiopulmonary abnormalities improve over time, though some measures remain abnormal relative to controls. Persistent symptoms at 6 months post-COVID-19 did not associate with objective measures of cardiopulmonary health.
The authors' work was supported by the NIHR Oxford Biomedical Research Centre, Oxford British Heart Foundation (BHF) Centre of Research Excellence (RE/18/3/34214), United Kingdom Research Innovation and Wellcome Trust. This project is part of a tier 3 study (C-MORE) within the collaborative research programme entitled PHOSP-COVID Post-hospitalization COVID-19 study: a national consortium to understand and improve long-term health outcomes, funded by the Medical Research Council and Department of Health and Social Care/National Institute for Health Research Grant (MR/V027859/1) ISRCTN number 10980107.
感染冠状病毒病（COVID-19）后心肺异常和症状的纵向轨迹尚不清楚。我们试图描述其在既往住院患者中的自然病史，与对照组进行比较，并评估COVID-19后6个月时症状与心肺功能损害之间的关系。
2020年3月14日至5月25日招募了58例患者和30例匹配的对照组（单次就诊），在COVID-19感染后3个月接受症状问卷调查、心脏和肺部磁共振成像（CMR）、心肺运动试验（CPET）以及肺活量测定。其中，46例患者在6个月时返回进行随访评估。
在2至3个月时，83%的患者至少有一种心肺症状，而对照组为33%。患者和对照组的双心室容积和功能相当。患者在2至3个月时，心肌T1值（纤维炎症标志物）和钆延迟强化（LGE，局灶性纤维化标志物）升高。60%的患者CMR显示肺实质异常，55%的患者CPET显示峰值摄氧量（pV̇O₂）降低。到6个月时，52%的患者仍有症状。在CMR上，右心室（RV）指数舒张末期容积减少（-4.3 ml/m²，P = 0.005），RV射血分数增加（+3.2%，P = 0.0003）。心肌T1值和LGE有所改善，与对照组相当。肺实质异常和峰值V̇O₂虽有所改善，但患者仍与对照组存在差异。31%的患者因症状限制和肌肉功能损害导致pV̇O₂降低。患者的心肺症状与CMR、肺功能或CPET测量结果无关。
在患者中，心肺异常随时间改善，尽管某些指标相对于对照组仍异常。COVID-19后6个月持续存在的症状与心肺健康的客观指标无关。
作者的工作得到了英国国家卫生研究院牛津生物医学研究中心、牛津英国心脏基金会（BHF）卓越研究中心（RE/18/3/34214）、英国研究与创新署和惠康信托基金会的支持。该项目是名为PHOSP-COVID住院后COVID-19研究的合作研究计划中的3级研究（C-MORE）的一部分：一个旨在了解和改善长期健康结局的全国性联盟，由医学研究理事会、卫生与社会保健部/国家卫生研究院资助（MR/V027859/1），国际标准随机对照试验编号10980107。
