Chamley Rebecca R, Holland Jennifer L, Collins Jonathan, Pierce Kayleigh, Watson William D, Green Peregrine G, O'Brien David, O'Sullivan Oliver, Barker-Davies Robert, Ladlow Peter, Neubauer Stefan, Bennett Alexander, Nicol Edward D, Holdsworth David A, Rider Oliver J
University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom; Defence COVID-19 Recovery Service, Stanford Hall, Loughborough, UK; Academic Department of Military Medicine, Birmingham, UK; Royal Centre for Defence Medicine (South), Oxford, UK.
University of Oxford Centre for Clinical Magnetic Resonance Research, Radcliffe Department of Medicine, Division of Cardiovascular Medicine, Oxford, United Kingdom.
Int J Cardiol. 2024 Jan 15;395:131594. doi: 10.1016/j.ijcard.2023.131594. Epub 2023 Nov 17.
Since the COVID-19 pandemic, post-COVID syndrome (persistent symptoms/complications lasting >12 weeks) continues to pose medical and economic challenges. In military personnel, where optimal fitness is crucial, prolonged limitations affecting their ability to perform duties has occupational and psychological implications, impacting deployability and retention. Research investigating post-COVID syndrome exercise capacity and cardiopulmonary effects in military personnel is limited.
UK military personnel were recruited from the Defence Medical Services COVID-19 Recovery Service. Participants were separated into healthy controls without prior SARS-CoV-2 infection (group one), and participants with prolonged symptoms (>12 weeks) after mild-moderate (community-treated) and severe (hospitalised) COVID-19 illness (group 2 and 3, respectively). Participants underwent cardiac magnetic resonance imaging (CMR) and spectroscopy, echocardiography, pulmonary function testing and cardiopulmonary exercise testing (CPET).
113 participants were recruited. When compared in ordered groups (one to three), CPET showed stepwise decreases in peak work, work at VT1 and VO max (all p < 0.01). There were stepwise decreases in FVC (p = 0.002), FEV (p = 0.005), TLC (p = 0.002), V (p < 0.001), and DLCO (p < 0.002), and a stepwise increase in A-a gradient (p < 0.001). CMR showed stepwise decreases in LV/RV volumes, stroke volumes and LV mass (LVEDVi/RVEDVi p < 0.001; LVSV p = 0.003; RVSV p = 0.001; LV mass index p = 0.049).
In an active military population, post-COVID syndrome is linked to subclinical changes in maximal exercise capacity. Alongside disease specific changes, many of these findings share the phenotype of deconditioning following prolonged illness or bedrest. Partitioning of the relative contribution of pathological changes from COVID-19 and deconditioning is challenging in post-COVID syndrome recovery.
自新冠疫情以来，新冠后综合征（持续症状/并发症持续超过12周）继续带来医学和经济挑战。在军事人员中，最佳体能至关重要，长期限制其履行职责的能力具有职业和心理影响，会影响可部署性和留用率。针对军事人员新冠后综合征运动能力和心肺效应的研究有限。
从国防医疗服务新冠康复服务部门招募英国军事人员。参与者被分为未感染过严重急性呼吸综合征冠状病毒2（SARS-CoV-2）的健康对照组（第一组），以及轻度至中度（社区治疗）和重度（住院）新冠疾病后出现长期症状（超过12周）的参与者（分别为第二组和第三组）。参与者接受了心脏磁共振成像（CMR）和波谱分析、超声心动图、肺功能测试和心肺运动测试（CPET）。
共招募了113名参与者。按顺序分组（一至三组）比较时，CPET显示峰值工作量、VT1时的工作量和最大摄氧量（VO₂max）逐步下降（均p<0.01）。用力肺活量（FVC）（p=0.002）、第一秒用力呼气容积（FEV）（p=0.005）、肺总量（TLC）（p=0.002）、肺活量（V）（p<0.001）和一氧化碳弥散量（DLCO）（p<0.002）逐步下降，肺泡动脉氧分压差（A-a梯度）逐步增加（p<0.001）。CMR显示左心室/右心室容积、每搏输出量和左心室质量逐步下降（左心室舒张末期容积指数/右心室舒张末期容积指数p<0.001；左心室每搏输出量p=0.003；右心室每搏输出量p=0.001；左心室质量指数p=0.049）。
在现役军人中，新冠后综合征与最大运动能力的亚临床变化有关。除了疾病特异性变化外，这些发现中的许多都与长期患病或卧床休息后的身体机能失调表型相同。在新冠后综合征恢复过程中，区分新冠病理变化和身体机能失调的相对贡献具有挑战性。
