Exercise response in post-acute coronary syndrome patients survived to COVID-19 infection, 2024, Provenzale et al.

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Exercise response in post-acute coronary syndrome patients survived to COVID-19 infection
Giovanni Provenzale; Lucia Barbieri; Gabriele Tumminello; Stefano Carugo; Marco Guazzi

AIMS
Many studies evaluated the functional response in post-Covid-19 patients; however, they systematically excluded patients with concomitant acute coronary syndrome (ACS).
We evaluated the long-term functional capacity assessed by cardiopulmonary exercise test (CPET) in patients hospitalized for ACS and concomitant SARS-CoV2 infection. The secondary aim was to investigate the functional response in patients with symptoms related to "long COVID-19 syndrome" (LCS).

METHODS
This cross-sectional case-control study compared 20 patients with ACS and concomitant SARS-COV2 infection with 20 patients without COVID-19. At the follow-up visit (between 6 and 12 months after revascularization procedure) all patients underwent a CPET.

RESULTS
Patients with previous ACS and concomitant COVID-19 showed a reduced O2 consumption than controls (predicted peak VO2 74.00% vs 86.70%; p = 0.01) with a high degree of ventilatory inefficiency (VE/ VCO2 slope 38.04 vs 30.31; p = 0.002). 50% of subjects with previous COVID-19 disease showed symptoms related to "LCS"; this subgroup demarcates the characteristic reduced exercise capacity found in the entire COVID + group.

CONCLUSIONS
This study is the first in literature having analyzed the long-term functional capacity phenotype in a population of ACS patients and concomitant SARS-CoV2 infection. Severe ventilatory inefficiency emerged as the functional signature of these patients. Moreover, the subset of patients with symptoms related to LCS has the most compromised long term reduced exercise capacity and an altered ventilation control.


Link | PDF (International Journal of Cardiology)

 

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They took patients who presented with an acute coronary syndrome and compared those with acute Covid (20 cases) against non-infected (20 controls). Followed up 6-12 months after coronary revascularisation, performing CPET. They also subdivided the cases into those that had LC via questionnaire (50%).

Matching was very good.

 

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At peak exercise, the average percent of predicted peak of V˙O2 was lower in COVID-19 patients than in controls (74.00 ± 16.59% vs 86.70 ± 15.56%; p = 0.017) and a significantly lower, although in the normal range, slope of oxygen uptake to work rate relationship (V˙O2/Work slope) was found in COVID-19 group (9.96 ± 2.13 vs 11.34 ± 1.97; p = 0.04). No differences were observed in peak O2 pulse, VO2 at anaerobic threshold and
breathing reserve.

Patients with COVID-19 peculiarly showed a high degree of VE inefficiency as signaled by a marked increase in VE/V˙CO2 slope (38.04 ± 9.23 vs 30.31 ± 4.10; p = 0.002).

Interestingly, patients with LCS + had a lower peak V˙O2 (16.15 ± 4.51 mL/kg/min vs 21.82 ± 7.02 mL/kg/min; p = 0.05). This group also showed a significant increase of VE/V˙CO2 slope (42.33 ± 8.18 vs 33.75 ± 8.49; p = 0.03) with a significantly lower resting PetCO2 (25.30 ± 2.75 mmHg vs 29.07 ± 5.19 mmHg; p = 0.05) compared to LCS -. However, PetCO2 AT and V˙O2/WR did not exhibit statistically significant difference. (See Tables 5 and 6.)

Our data are the first analysing the CPET performance of post-Covid 19 patients who developed an ACS episode during the infection compared to similar ACS patients Covid-19 free. New findings are: 1) a remarkable VE inefficiency rather than V˙O2 impairment emerged as the CPET signature of these patients: 2) The most severe phenotype of VE inefficiency is detectable in the subset developing the “long post-Covid 19” condition; [...]