Chandelier
Senior Member (Voting Rights)
Medium- to long-term health condition of patients post-COVID-19, exercise intolerance and potential mechanisms: A narrative review and perspective
Uncertainty remains about long-term recovery.
We aimed to review studies examining cardiac function, macro- or microvascular function, blood biomarkers and physical activity in adult patients post-COVID-19 and highlight current knowledge gaps.
Ventricular dysfunction was often subclinical but may partly contribute to exercise intolerance post-COVID-19.
Endothelial dysfunction was seen on micro- and macrovascular levels using retinal vessel imaging methods and brachial artery flow-mediated dilation, respectively.
Studies reporting blood biomarkers of disease-specific impairment and endothelial dysfunction yielded upregulated inflammation, hypercoagulability, organ and endothelial damage up to several months after infection.
Omics’ scale lipid profiling studies provide preliminary evidence of alterations in several lipid subspecies, mostly during acute COVID-19, which might contribute to subsequent endothelial and cardiometabolic dysfunction. Yet, more robust evidence is warranted.
Physical activity may be reduced up to 6 months post-COVID-19.
However, studies measuring physical activity more precisely using accelerometry are sparse.
Overall, there is growing evidence for long-term multiple organ dysfunction.
Moreover, studies with longer follow-ups (i.e. ⩾18 months) and well-matched control groups are lacking.
The findings may aid the development of rehabilitation regimes for post-COVID-19 syndrome.
Evidence suggests long-term dysfunction in multiple organ systems and exercise intolerance due to various factors, including endothelial damage and, in some patients, subclinical ventricular dysfunction.
We highlight knowledge gaps for further research to aid post-COVID-19 rehabilitation.
Taking into account the individual’s health conditions and recovery trajectories is vital.
Web | DOI | PMC | PDF | SAGE Open Medicine | Open Access
Schwendinger, Fabian; Infanger, Denis; Maurer, Debbie J; Radtke, Thomas; Carrard, Justin; Kröpfl, Julia M; Emmenegger, Aglaia; Hanssen, Henner; Hauser, Christoph; Schwehr, Udo; Hirsch, Hans H; Ivanisevic, Julijana; Leuzinger, Karoline; Martinez, Aurélien E; Maurer, Marc; Sigrist, Thomas; Streese, Lukas; von Känel, Roland; Hinrichs, Timo; Schmidt-Trucksäss, Arno
Abstract
Background:
Patients recovering from COVID-19 often present with impaired health and persisting symptoms such as exercise intolerance ⩾3 months post-infection.Uncertainty remains about long-term recovery.
We aimed to review studies examining cardiac function, macro- or microvascular function, blood biomarkers and physical activity in adult patients post-COVID-19 and highlight current knowledge gaps.
Results:
Using echocardiography, persistent cardiac involvement of the left ventricle was observed in a fraction of patients both hospitalized and non-hospitalized.Ventricular dysfunction was often subclinical but may partly contribute to exercise intolerance post-COVID-19.
Endothelial dysfunction was seen on micro- and macrovascular levels using retinal vessel imaging methods and brachial artery flow-mediated dilation, respectively.
Studies reporting blood biomarkers of disease-specific impairment and endothelial dysfunction yielded upregulated inflammation, hypercoagulability, organ and endothelial damage up to several months after infection.
Omics’ scale lipid profiling studies provide preliminary evidence of alterations in several lipid subspecies, mostly during acute COVID-19, which might contribute to subsequent endothelial and cardiometabolic dysfunction. Yet, more robust evidence is warranted.
Physical activity may be reduced up to 6 months post-COVID-19.
However, studies measuring physical activity more precisely using accelerometry are sparse.
Overall, there is growing evidence for long-term multiple organ dysfunction.
Conclusion:
Research combining all the above methods in the search for underlying mechanisms of post-COVID-19 symptoms is mostly missing.Moreover, studies with longer follow-ups (i.e. ⩾18 months) and well-matched control groups are lacking.
The findings may aid the development of rehabilitation regimes for post-COVID-19 syndrome.
Condensed abstract
This review examined cardiac function, vascular function, blood biomarkers and physical activity in patients post-COVID-19.Evidence suggests long-term dysfunction in multiple organ systems and exercise intolerance due to various factors, including endothelial damage and, in some patients, subclinical ventricular dysfunction.
We highlight knowledge gaps for further research to aid post-COVID-19 rehabilitation.
Key perspective
- Patients post-COVID-19 may exhibit sequelae in multiple organs, contributing to low cardiorespiratory fitness and exercise intolerance.
Imaging evidence shows persistent impaired micro- and macrovascular endothelial function and mostly subclinical cardiac involvement in patients post-COVID-19, which might be related to these challenges.
- The exact mechanisms and long-term effects of these cardiovascular changes remain unclear, indicating a need for further research to fully understand and address these post-COVID-19 health challenges.
- The findings have implications for clinical practice, as they inform the development of targeted rehabilitation programs for patients post-COVID-19.
Taking into account the individual’s health conditions and recovery trajectories is vital.
Web | DOI | PMC | PDF | SAGE Open Medicine | Open Access