Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, United States of America.
Department of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States of America.
Prog Cardiovasc Dis. 2024 Mar-Apr;83:71-76. doi: 10.1016/j.pcad.2023.05.005. Epub 2023 May 19.
Dyspnea and fatigue are characteristics of long SARS-CoV-2 (COVID)-19. Cardiopulmonary exercise testing (CPET) can be used to better evaluate such patients.
How significantly and by what mechanisms is exercise capacity impaired in patients with long COVID who are coming to a specialized clinic for evaluation?
We performed a cohort study using the Mayo Clinic exercise testing database. Subjects included consecutive long COVID patients without prior history of heart or lung disease sent from the Post-COVID Care Clinic for CPET. They were compared to a historical group of non-COVID patients with undifferentiated dyspnea also without known cardiac or pulmonary disease. Statistical comparisons were performed by t-test or Pearson's chi test controlling for age, sex, and beta blocker use where appropriate.
We found 77 patients with long COVID and 766 control patients. Long COVID patients were younger (47 ± 15 vs 50 ± 10 years, P < .01) and more likely female (70% vs 58%, P < .01). The most prominent difference on CPETs was lower percent predicted peak V̇O (73 ± 18 vs 85 ± 23%, p < .0001). Autonomic abnormalities (resting tachycardia, CNS changes, low systolic blood pressure) were seen during CPET more commonly in long COVID patients (34 vs 23%, P < .04), while mild pulmonary abnormalities (mild desaturation, limited breathing reserve, elevated V̇/V̇CO) during CPET were similar (19% in both groups) with only 1 long COVID patient showing severe impairment.
We identified severe exercise limitation among long COVID patients. Young women may be at higher risk for these complications. Though mild pulmonary and autonomic impairment were common in long COVID patients, marked limitations were uncommon. We hope our observations help to untangle the physiologic abnormalities responsible for the symptomatology of long COVID.
呼吸困难和疲劳是长新冠的特征。心肺运动测试（CPET）可用于更好地评估此类患者。
来到专门诊所接受评估的长新冠患者的运动能力受损程度如何？其机制是什么？
我们使用梅奥诊所的运动测试数据库进行了一项队列研究。研究对象包括因长新冠而从新冠后护理诊所转介来进行 CPET 的连续长新冠患者，以及无已知心肺疾病的、因不明原因呼吸困难而就诊的、无新冠病史的历史对照组患者。通过 t 检验或 Pearson 卡方检验进行统计学比较，并根据年龄、性别和β受体阻滞剂的使用情况进行适当调整。
我们纳入了 77 例长新冠患者和 766 例对照组患者。长新冠患者更年轻（47 ± 15 岁 vs 50 ± 10 岁，P < 0.01），更有可能为女性（70% vs 58%，P < 0.01）。CPET 中最显著的差异是峰值 V̇O 预测值的百分比较低（73 ± 18% vs 85 ± 23%，p < 0.0001）。长新冠患者在 CPET 期间更常出现自主神经异常（静息心动过速、中枢神经系统改变、收缩压低）（34% vs 23%，P < 0.04），而 CPET 期间轻度的肺功能异常（轻度低氧血症、呼吸储备有限、V̇/V̇CO 升高）在两组中相似（均为 19%），仅有 1 例长新冠患者表现为严重损害。
我们发现长新冠患者存在严重的运动受限。年轻女性可能面临更高的这些并发症风险。虽然长新冠患者中常见轻度肺和自主神经损伤，但严重的限制并不常见。我们希望我们的观察结果有助于厘清导致长新冠症状的生理异常。
Zotero 插件