Uzel Fatma Isil, Peker Yüksel, Atceken Zeynep, Karatas Ferhan, Atasoy Cetin, Caglayan Benan
Department of Pulmonary Medicine, School of Medicine, Koc University, Istanbul 34010, Türkiye.
Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, 40530 Gothenburg, Sweden.
J Clin Med. 2025 Jan 13;14(2):475. doi: 10.3390/jcm14020475.
We aimed to describe the cardiopulmonary function during exercise and the health-related quality of life (HRQoL) in patients with a history of COVID-19 pneumonia, stratified by chest computed tomography (CT) findings at baseline. Among 77 consecutive patients with COVID-19 who were discharged from the Pulmonology Ward between March 2020 and April 2021, 28 (mean age 54.3 ± 8.6 years, 8 females) agreed to participate to the current study. The participants were analyzed in two groups based on pulmonary involvement (PI) at baseline chest CT applying a threshold of 25%. A consequent artificial intelligence (AI)-guided total opacity score (TOS) was calculated in a subgroup of 22 patients. A cardiopulmonary exercise test (CPET) was conducted on average 8.4 (±1.9) months after discharge from the hospital. HRQoL was defined using the short-form (SF-36) questionnaire. The primary outcome was exercise intolerance that was defined as a peak oxygen uptake (V'O) < 80% predicted. Secondary outcomes were ventilatory limitation, defined as breathing reserve < 15%, circulatory limitation, defined as oxygen pulse predicted below 80%, and deconditioning, defined as exercise intolerance in the absence of ventilatory and circulatory limitations. Other secondary outcomes included the SF-36 domains. In all, 15 patients had at least 25% PI (53.6%) at baseline chest CT. Exercise intolerance was observed in ten patients (35.7%), six due to deconditioning and four due to circulatory limitation; none had ventilatory limitation. AI-guided TOS was 30.1 ± 24.4% vs. 6.1 ± 4.8% ( < 0.001) at baseline, and 1.7 ± 3.0% vs. 0.2 ± 0.7% (nonsignificant) at follow-up in high and low PI groups, respectively. The physical functioning (PF) domain score of the SF-36 questionnaire was 66.3 ± 19.4 vs. 85.0 ± 13.1 in high and low PI groups, respectively ( = 0.007). Other SF-36 domains did not differ significantly between the groups. A high PI at baseline was inversely correlated with V'O (standardized β coefficient = -0.436; 95% CI -26.1; -0.7; = 0.040) and with PF scores (standardized β coefficient -0.654; 95% CI -41.3; -7.6; = 0.006) adjusted for age, sex, body mass index and lung diffusion capacity. One-third of participants experienced exercise intolerance eight months after COVID-19 pneumonia. A higher PI at baseline was significantly associated with exercise intolerance and PF. Notwithstanding, the radiological PI was resolved, and the exercise intolerance was mainly explained not by ventilatory limitation but by circulatory limitation and deconditioning.
我们旨在描述有新冠病毒肺炎病史患者运动期间的心肺功能以及与健康相关的生活质量（HRQoL），并根据基线胸部计算机断层扫描（CT）结果进行分层。在2020年3月至2021年4月间从肺病科病房出院的77例连续新冠病毒患者中，28例（平均年龄54.3±8.6岁，8名女性）同意参与本研究。根据基线胸部CT上肺部受累（PI）情况，以25%为阈值将参与者分为两组。随后在22例患者的亚组中计算了人工智能（AI）引导下的总不透明度评分（TOS）。在出院后平均8.4（±1.9）个月进行了心肺运动试验（CPET）。使用简短形式（SF - 36）问卷定义HRQoL。主要结局是运动不耐受，定义为峰值摄氧量（V'O）<预测值的80%。次要结局包括通气受限，定义为呼吸储备<15%；循环受限，定义为氧脉搏<预测值的80%；以及失健，定义为在无通气和循环受限情况下的运动不耐受。其他次要结局包括SF - 36各领域。总共15例患者在基线胸部CT时有至少25%的PI（53.6%）。10例患者（35.7%）观察到运动不耐受，6例由于失健，4例由于循环受限；无人有通气受限。在高PI组和低PI组中，基线时AI引导下的TOS分别为30.1±24.4%和6.1±4.8%（<0.001），随访时分别为1.7±3.0%和0.2±0.7%（无显著差异）。SF - 36问卷的身体功能（PF）领域评分在高PI组和低PI组中分别为66.3±19.4和85.0±13.1（=0.007）。两组间其他SF - 36领域无显著差异。经年龄、性别、体重指数和肺扩散能力校正后，基线时高PI与V'O（标准化β系数=-0.436；95%可信区间-26.1；-0.7；=0.040）和PF评分（标准化β系数-0.654；95%可信区间-41.3；-7.6；=0.006）呈负相关。三分之一的参与者在新冠病毒肺炎八个月后出现运动不耐受。基线时较高的PI与运动不耐受和PF显著相关。尽管如此，放射学上的PI已消退，运动不耐受主要不是由通气受限解释，而是由循环受限和失健解释。
